에탐부톨 유발 독성 시신경병증과 동반된 철결핍성 빈혈에 의한 허혈시신경병증
Ischemic Optic Neuropathy Caused by Iron Deficiency Anemia Accompanied by Ethambutol-induced Toxic Optic Neuropathy
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목적: 에탐부톨에 의한 시신경병증과 철결핍성 빈혈에 의한 시신경병증이 동반된 1예를 보고하고자 한다. 증례요약: 64세 여자 환자가 한 달 전부터 서서히 시작된 양안의 무통성 시력저하를 주소로 내원하였다. 4개월 전부터 결핵 치료를 위해 에탐부톨을 매일 복용 중이었다. 교정시력은 양안 0.3으로 측정되었으며, 시야검사상 양안 중심시야 결손이 관찰되었다. 색각검사는 우안 3개, 좌안 2개를 맞추었다. 에탐부톨 복용으로 인한 독성 시신경병증 의심하 약물 복용을 바로 중단하였으나, 교정시력은 점차 악화되어 우안 0.05, 좌안 안전수지 50 cm로 떨어졌다. 환자의 혈액검사 결과 철결핍성 빈혈 소견을 보여 치료를 시작하였고, 5개월 후 혈액검사 결과 정상으로 회복되고 교정시력 양안 0.5까지 호전되었으나, 빛간섭단층촬영상 신경절세포-속얼기층의 손상이 관찰되어 추후 지속적인 경과 관찰 예정이다. 결론: 철결핍성 빈혈에 의한 허혈시신경병증은 단기간에 발생할 수 있으며, 에탐부톨에 의한 독성 시신경병증과 동반되어 감별이 어려울 수 있다. 점진적 시력저하로 오는 환자들의 경우, 명확한 시력저하의 요인이 있더라도 다각도로 평가하여 신속히 진단하고 치료하는 것이 중요하다.
Abstract
Purpose: To report a case of ischemic optic neuropathy caused by iron deficiency anemia (IDA) accompanied by ethambutol-induced toxic optic neuropathy. Case summary: A 64-year-old female patient presented with declining visual acuity. Four months prior, she had been taking ethambutol daily for tuberculosis. Corrected visual acuity was 0.3 in both eyes and a central visual field defect was revealed in visual field tests. In the color vision test, the right eye scored three and the left eye scored two. Ethambutol was stopped immediately under suspicion of toxic optic neuropathy; however, the corrected visual acuity gradually worsened to 0.05 in the right eye and the finger count was 50 cm in the left eye. The patient’s blood test showed signs of IDA. After 5 months of IDA treatment, the blood test results returned to the normal range and corrected visual acuity improved to 0.5 in both eyes. However, focal atrophy of the ganglion cell-inner plexiform layer was observed, requiring close monitoring of optical coherence tomography findings. Conclusions: Ischemic optic neuropathy due to IDA may occur in a short period of time and may be difficult to diagnose if accompanied by ethambutol-induced toxic optic neuropathy. In the case of patients with progressive vision loss, prompt diagnosis and careful monitoring in follow-up evaluations are required.
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