국소성 분절성 사구체 경화증 환자에서 독성 거대결장으로 발현된 거대세포바이러스 대장염 1예
Cytomegalovirus colitis causing toxic megacolon in a patient with focal segmental glomerulosclerosis
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저자들은 국소성 분절성 사구체 경화증 환자에서 하행 결장의 분절성 협착과 동반된 독성 거대결장의 형태로 발현한 거대세포바이러스 대장염 1예를 성공적으로 치료하였기에 보고하는 바이다. 본 증례로 보아 거대세포바이러스 대장염은 출혈, 궤양뿐만 아니라 협착, 독성 거대결장 등 다양한 임상양상을 보일 수 있었으며, 국소성 분절성 사구체 경화증과의 연관성은 분명하지 않았다.
Abstract
Cytomegalovirus is a frequent opportunistic pathogen in immunosuppressed patients and CMV colitis is one of its major complications. It usually presents as gastrointestinal ulceration with bleeding or perforation, but it can also take less common forms resembling many other entities, including viral gastroenteritis, ischemic colitis, intestinal pseudo-obstuction, toxic megacolon. We experienced a 49-year-old man with symptom of severe constipation and lower abdominal pain. He was diagnosed as having focal segmental glomerulosclerosis by renal biopsy, but he was an immunocompetent state. An abdominal X-ray showed marked dilatation of descending colon without air-fluid level. At colonoscopy and biopsy, he was diagnosed as having CMV colitis with focal stenosis. Treatment for two weeks with ganciclovir resulted in resolution of colitis, but stenosis was remained. We report a case of toxic megacolon and focal stenosis due to CMV colitis in a FSGS patient. It was not certain whether FSGS was related with immunosuppressive state.(Korean J Med 63:720-724, 2002)