전방축농을 동반한 반복적인 헤르페스포도막염 의증 1예
Presumptive Diagnosis of Recurrent Herpes-induced Anterior Uveitis with Acute Hypopyon
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목적: 외상 후 전방축농을 동반한 반복적인 헤르페스포도막염 의증 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 82세 남자 환자가 과거 병력상 좌안의 수지상 각막염으로 헤르페스각막염 진단하 항바이러스제 치료 후 병변이 소실되었다. 그러나 환자는 1년 후에 외상 후 발생한 좌안의 시력저하, 통증, 눈물흘림을 주소로 재내원하였다. 시력은 안전수지, 안압은 27 mmHg였으며, 세극등검사에서 중심부 각막미란, 중증도의 각막 실질부종 및 2 mm의 전방축농이 관찰되었다. 이에 외상에 의해 급격히 진행된 세균성 안내염으로 판단하여 배양검사 및 유리체강 내 항생제주입술을 시행하였다. 또한 병변의 임상 양상 및 과거 헤르페스각막염 치료력을 고려할 때 헤르페스 바이러스 감염도 배제할 수 없어서 항바이러스제 치료를 함께 시행하였다. 배양검사상 균이 검출되지 않았고 증상이 호전되어 2개월간 항바이러스제 치료를 서서히 중단하였다. 그러나 항바이러스제 치료를 중단한 지 5일째에 전방축농을 동반한 재발 소견이 관찰되었으며, 재발성 헤르페스포도막염으로 의심하에 다시 항바이러스제 및 스테로이드 치료를 하였고, 증상 및 시력이 회복되었다. 결론: 외상 후 급격한 전방축농이 발생한 환자에서 세균성 홍채염 및 안내염뿐만 아니라, 바이러스성 전안부 포도막염 또한 감별 진단으로 반드시 고려하여야 한다.
Abstract
Purpose: We report an unusual case of presumptive diagnosis of herpes-induced anterior uveitis with acute hypopyon after trauma. Case summary: A 82-year-old male was diagnosed with herpes keratitis due to dendritic keratitis in the left eye, and the lesion disappeared after antiviral treatment. However, 1 year later, the patient visited again with visual loss, pain, and tearing of the left eye after trauma. At the examination, best-corrected visual acuity was counting fingers and the intraocular pressure was 27 mmHg in the left eye. Slit-lamp examination revealed corneal epithelial erosion, moderate corneal edema, and prominent inflammation with 2 mm high hypopyon in the anterior chamber. We thought that bacterial endophthalmitis had rapidly progressed after trauma, so we performed bacterial cultures and an intravitreal antibiotics injection. Considering the clinical manifestations of lesions and herpes keratitis in the past, we could not exclude herpes virus infection. Cultures were negative and the symptoms improved, so the antiviral treatment was gradually reduced and stopped at 2 months. However, recurrence was observed on day 5 after stopping antiviral therapy. We therefore assumed that recurrent herpes virus caused anterior uveitis, and then, antiviral and steroid therapy was resumed. The patient subsequently showed improvement in his symptoms and recovered his visual acuity. Conclusions: When acute hypopyon is observed in the anterior chamber after trauma, not only bacterial iritis and endophthalmitis but also viral-induced anterior uveitis should be considered in the differential diagnosis.
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