크론병 환자에서 Infliximab 사용과 관련된 시신경염: 증례 보고 및 문헌 고찰
Infliximab-related Optic Neuritis in a Patient with Crohn's Disease: a Case Report and Literature Review
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목적: 크론병으로 infliximab 치료를 받는 환자에서 발생한 시신경염 1예를 문헌고찰과 함께 보고하고자 한다. 증례요약: 22세 남자 환자가 2-3주 전부터 좌안의 시야가 흐려지는 증상으로 내원하였다. 좌안의 최대교정시력이 0.4로 저하되어 있었고, 상대구심동공운동장애가 관찰되었으나, 안구운동 시의 통증과 동공부등은 없었다. 좌안의 색각이 저하되어 있었고, 시야검사상 좌안의 중심하측시야결손이 보였으나, 안저검사상 시신경유두 및 황반의 특이 소견은 없었다. 시신경병증의 원인 감별을 위해 시행한 안와 자기공명영상에서 좌측 시신경이 조영증강되었고, 그 외 다른 문제는 관찰되지 않았다. 환자는 크론병으로 종양괴사인자(tumor necrosis factor, TNF)-α 억제제 중 하나인 infliximab 600 mg을 2개월마다 주사치료 중이었고, 이와 연관된 구후시신경염으로 의심하에 고용량 스테로이드 정맥주사 및 경구복용을 하였고, 이 후 3개월째 시력 및 시야가 호전되었다. 결론: TNF-α 억제제의 사용이 시신경염을 유발할 수 있으므로, 시신경염 발생 시 환자의 약제 사용 여부에 대한 면밀한 병력 청취를 통해, 원인 감별 및 치료 방향 설정을 해야 할 것이다.
Abstract
Purpose: We report a case of optic neuritis related to infliximab treatment in a patient with Crohn’s disease, along with a review of the relevant literature. Case summary: A 22-year-male patient complained of blurred vision in the left eye for 2-3 weeks. His best-corrected visual acuity was 8/20 in the left eye. Relative afferent pupillary defect was detected in the left eye and the pupils were of equal size. There was no pain on ocular movement. The results of slit-lamp and fundus examinations were normal. A visual field test revealed a central to inferior visual field defect in the left eye. Orbit magnetic resonance imaging revealed perineural enhancement of the left optic nerve. He had a 5-year history of Crohn’s disease and had been treated with intravenous infliximab (600 mg every 2 weeks). A diagnosis of retrobulbar optic neuritis associated with infliximab was made. He was infused with high-dose methylprednisolone, which was changed to per oral administration. His visual acuity and visual field defect improved after 3 months. Conclusions: Tumor necrosis factor-α inhibitors, such as infliximab, may cause optic neuritis. Therefore, history-taking is important for differential diagnosis and appropriate treatment.
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