류마티스 관절염에서 발생한 급성 횡단척수염 치료 1예
Acute Transverse Myelitis in a Patient with Rheumatoid Arthritis Treated with Intravenous Immunoglobulin
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초록
급성 횡단척수염은 급성으로 발생하는 척수의 염증성 장애로 사지마비, 감각이상, 자율신경계 이상을 보이는 질환이다[1]. 급성 횡단척수염은 드문 질환으로 유병률은 백만 명당 1.34-4.60명 정도이며 모든 나이에서 생길 수 있으나 10대와 30대에 호발한다[1]. 류마티스 관절염 환자에서 고리중쇠관절 부분탈구(atlantoaxial subluxation) 없이 경추의 척수증이동반되는 경우는 매우 드문 것으로 알려져 있다[2]. 저자들은 류마티스 관절염 환자에서 발생한 급성 횡단 척수염 1예를 경험하였다. 일반적으로 급성횡단척수염의 일차 치료제는 고용량의 당질코르티코이드이다[1]. 그러나 본 증례에서는 동반질환으로 인하여 고용량의 당질코르티코이드를 투여하기에는 부작용이 우려되어 정주 면역글로불린(intravenous immunoglobulin)으로 치료하였으며 임상적인 회복을 보였다. 저자들은 류마티스 관절염에서 동반된 급성 횡단 척수염을 면역글로불린 투여로 치료한 증례를 경험하였기에 보고하는바이다.
Abstract
Acute transverse myelitis (ATM) is a heterogeneous syndrome characterized by acute spinal cord dysfunction resulting in paresis and sensory and autonomic impairment below the level of the lesion. The etiology of ATM includes parainfectious, paraneoplastic, drug-induced, systemic autoimmune disorders, and acquired demyelinating diseases. ATM is very rare in patients with rheumatoid arthritis (RA). A 79-year-old woman with RA, a recurring peptic ulcer, and congestive heart failure presented with acute weakness of both upper and lower extremities. She was diagnosed with ATM based on the results of laboratory and radiological tests. ATM is usually treated with high-dose glucocorticoid. However, we treated her with intravenous immunoglobulin (IVIG) considering the adverse events of high-dose glucocorticoid, and she improved. We report a case of ATM in a patient with RA successfully treated with IVIG.
참고문헌 (10)
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