회복기 색소침착을 보이는 비전형적 소실성다발백반증후군
Atypical Multiple Evanescent White Dot Syndrome with Pigmented Patches of Recovery Phase
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목적: 소실성다발백반증후군에서 급성기 백색반점과 서로 다른 부위에 회복기 색소침착이 발생한 증례 1예를 보고하고자 한다. 증례요약: 특이 전신질환이 없는 17세 남자가 좌안의 시력저하를 주소로 내원하였다. 첫 내원 시 최대교정시력 우안 1.0, 좌안 0.5였고, 안저검사상 좌안 비측 망막에 경계가 불명한 백색반점이 관찰되었다. 빛간섭단층촬영상 황반부 시세포층의 와해 소견이 보였고, 백색반점 부위에서 형광안저혈관조영술상 초기와 후기에 과형광, 인도시아닌그린혈관조영술상 후기 저형광이 관찰되었다. 소실성다발백반증후군으로 진단 후 치료 없이 경과 관찰하였다. 첫 내원으로부터 6주 후 경과 관찰상 좌안 교정시력 1.0으로 회복되었다. 이때 이측을 포함한 망막 전 영역에 걸쳐 산발적으로 망막모세혈관 주위 혹은 그 말단에 다발성 색소침착이 관찰되었다. 이후 특이 치료 없이 경과 관찰하는 중 회복기에 발생한 색소침착은 시간이 지남에 따라 소실되었다. 결론: 소실성다발백반증후군에서 급성기 백색반점이 없던 위치에 혈관을 따라 회복기 다발성 색소침착 반점이 발생할 수 있고 이후 소실됨을 관찰할 수 있다.
Abstract
Purpose: In the present study, an atypical case of multiple evanescent white dot syndrome (MEWDS) was reported, which the white dots of acute phase and the pigmented patches of recovery phase appeared on different location. Case summary: A seventeen years old male with no previous medical history was presented with decreased visual acuity of his left eye. On the first visit, his maximum corrected vision was 1.0 in right eye and 0.5 in left eye. The white dots with blurry margin were noted at the nasal retina on fundus exam. Fundus autofluorescence photography, fluorescein angiography and indocyanine green angiography all showed typical foundings of MEWDS. Gradually the vision improved up to 1.0 with maximum correction in six weeks, with normalized ellipsoid zone contour. However, multiple panretinal pigmented patches appeared diffusely, not only at nasal, where the previous white spots were noted, but also at temporal. The patient was followed up without any medication. Finally, the pigmented lesions were disappeared spontaneously. Conclusions: During the recovery phase of MEWDS, multiple pigmentations may appear in different part of the retina, where the white dots were not presented. However, they were disappeared with recovery of clinical symptoms gradually without any treatment.
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