급성 A형간염 후 발생한 Guillain-Barr？ 증후군 1예
A Case of Acute Hepatitis A Complicated by Guillain-Barr？ Syndrome
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급성 A형간염과 연관되어 발생한 것으로 생각되는 Guillain-Barr 증후군 1예를 보고하고자 한다. 32세 남자가 전신쇠약감과 황달로 내원하여 혈청바이러스검사에서 IgM anti-HAV가 검출되어 급성 A형간염으로 진단받았다. 환자는 입원 5일째에 대칭의 상행 운동마비가 발생하였고 뇌척수액검사에서 단백-세포 해리 소견 및 신경전도검사에서 다발신경근병증 소견을 보여 Guillain-Barr 증후군으로 진단하였다. 입원 9일째에 호흡근 약화에 의한 호흡기능상실이 발생하여 인공호흡기 치료를 시작하였고 면역글로불린 정주를 시행하였다. 이후 환자는 입원 90일째 보조기를 이용하여 보행 가능한 상태로 퇴원하였으나 일반적인 Guillain-Barr 증후군과 비교하여 회복 기간이 길었고 신경 증상의 후유증도 심한 편에 속하였다. 본 사례에서 Guillain- Barr 증후군 발생 전에 급성 A형간염이 선행하였다는 점에서 두 질병의 인과관계를 생각해 볼 수 있겠다.
Abstract
We report here a case of acute hepatitis A, which was complicated by Guillain-Barré syndrome (GBS). A 32-year old male admitted to our hospital with the symptoms of acute hepatitis and was diagnosed to have acute hepatitis A with positive IgM anti hepatitis A virus antibody. On 9th day after the onset of jaundice, acute progressive, ascending, symmetric motor paralysis were developed and eventually respiratory failure ensued. Cerebrospinal fluid analysis showed albumino-cytologic dissociation and nerve conduction velocity test suggested a polyradiculopathy. He was diagnosed to have GBS and treated with intravenous immunoglobulin and required a ventilatory support. After 90 hospital days, he recovered in ambulatory condition with the aid of crutches. The clinical course, prognosis and the outcome of neuropathic symptoms of GBS following acute hepatitis A were relatively poor in our case. (Korean J Hepatol 2007;13:228-233)
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