캐슬만병과 동반된 공막염 1예
Scleritis in a Patient with Castleman Disease
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목적: 캐슬만병은 주로 종격동을 침범하는 국소 림프증식성 질환으로 공막염이 동반된 증례를 경험하였기에 이를 보고하고자 한다. 증례요약: 42세 남자 환자가 5일 전부터 시작된 좌안의 시력저하를 주소로 내원하였다. 안과 내원 1년 9개월 전 혈액종양 내과에서 캐슬만병으로 진단받아 전신 스테로이드 치료와 복합 항암제 치료를 받은 병력이 있었다. 좌안 최대교정시력은 0.02, 안압은 42 mmHg였다. 세극등현미경검사에서 공막 및 각막의 부종이 있었으며, 전방 내 세포는 2+로 관찰되었다. 안저는 각막 부종으로 관찰되지 않았다. 1개월 후 우안의 공막염이 새로 발생하고 안통을 호소하였다. 국소 스테로이드와 비스테로이드 항염증제를 처방하였다. 반복되는 공막염과 전안부 염증으로 좌안에 백내장수술과 홍채절개술을 시행하였으며 전신스테로이드와 methotrexate 대사길항제를 처방하였다. 경과관찰 9년째 모든 약물을 중지하였으며 염증의 재발 없이 최대교정시력은 양안 모두 1.0이었다. 결론: 캐슬만병에 공막염이 동반될 수 있으며, 전신 스테로이드 치료와 methotrexate 병합 치료로 장기간 경과관찰에도 양호한 예후를 보였다.
Abstract
Purpose: To report a case of multicentric Castleman disease that presented with scleritis. Case summary: A 42-year-old male presented with decreased visual acuity in the left eye. Castleman disease had been diagnosed 21 months before and treated with systemic steroids and combined chemotherapy. Best-corrected visual acuity (BCVA) of the left eye was 0.02 and the intraocular pressure was 42 mmHg. Scleral edema and corneal edema were noted using a slit lamp examination. The anterior chamber cell was 2+ according to Standardization of Uveitis Nomenclature criteria. The fundus was invisible due to the anterior segment lesion. After one month, scleritis developed in the right eye and the patient complained of ocular pain. Topical steroids and non-steroidal anti-inflammatory drugs were prescribed. Due to recurrent scleritis and anterior uveitis, cataract extraction and laser iridectomy were performed on the left eye, and systemic steroids and the antimetabolite methotrexate were started. After 9 years of follow-up, all medications were stopped and there was no recurrence of inflammation, with a BCVA of 1.0 in both eyes. Conclusions: Treatment of a patient with scleritis accompanied with Castleman disease using systemic steroids and methotrexate resulted in a good prognosis.
참고문헌 (23)
- Castleman B, "Localized mediastinal lymphnode hyperplasia resembling thymoma", Cancer, 9, pp.822~830 (1956)[DOI]
- Herrada J, "The clinical behavior of localized and multicentric Castleman disease", Ann Intern Med, 128, pp.657~662 (1998)[DOI]
- Frizzera G, "A systemic lymphoproliferative disorder with morphologic features of Castleman's disease: clinical findings and clinicopathologic correlations in 15 patients", J Clin Oncol, 3, pp.1202~1216 (1985)[DOI]
- Chang Y, "Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma", Science, 266, pp.1865~1869 (1994)[DOI]
- Ishiyama T, "Interleukin-6 receptor expression in the peripheral B cells of patients with multicentric Castleman's disease", Ann Hematol, 73, pp.179~182 (1996)[DOI]
- Pavlidis NA, "A successfully treated case of multicentric angiofollicular hyperplasia with oral chemotherapy (Castleman's disease)", Med Pediatr Oncol, 18, pp.333~335 (1990)[DOI]
- Liberato NL, "Autoimmune hemolytic anemia in multicentric Castleman's disease", Haematologica, 81, pp.40~43 (1996)
- Jorge R, "Ocular findings in a patient with Castleman's disease before and after treatment with immunosuppression and plasmapheresis", Ophthalmic Surg Lasers Imaging, 41 (2010)[DOI]
- Venizelos I, "Orbital involvement in Castleman disease", Surv Ophthalmol, 55, pp.247~255 (2010)[DOI]
- Nishimoto N, "Improvement in Castleman's disease by humanized anti-interleukin-6 receptor antibody therapy", Blood, 95, pp.56~61 (2000)
- Inatani M, "Orbital pseudotumor as an initial manifestation of multicentric Castleman's disease", Jpn J Ophthalmol, 49, pp.505~508 (2005)[DOI]
- Severson GS, "Castleman's disease of the leptomeninges. Report of three cases", J Neurosurg, 69, pp.283~286 (1988)[DOI]
- Tavoni A, "Multicentric Castleman's disease in a patient with primary Sjogren's syndrome", Rheumatol Int, 12, pp.251~253 (1993)
- Koppens JM, "Castleman's disease of the lacrimal gland", Clin Exp Ophthalmol, 32, pp.108~110 (2004)[DOI]
- Sang Hoon Park, "Castleman’s Disease Presenting with Uveal Effusion Syndrome", Korean Journal of Ophthalmology, 24(3), pp.182~185 (2010), 대한안과학회
- 김응수, "Optic Neuropathy Associated with Castleman Disease", Korean Journal of Ophthalmology, 24(4), pp.256~259 (2010), 대한안과학회
- Liu DT, "Hypertensive choroidopathy in Castleman's disease", Graefes Arch Clin Exp Ophthalmol, 249, pp.1901~1903 (2011)[DOI]
- Oshitari T, "Refractory uveitis in patient with castleman disease successfully treated with tocilizumab", Case Rep Ophthalmol Med, 2012, pp.968180~ (2012)
- Kozak I, "Retinal vein occlusion during flare of multicentric Castleman's disease", Clin Ophthalmol, 7, pp.1647~1649 (2013)
- Katz MS, "Posterior segment involvement in Castleman disease", Retin Cases Brief Rep, 8, pp.209~211 (2014)[DOI]
- Lin P, "Immunologic markers as potential predictors of systemic autoimmune disease in patients with idiopathic scleritis", Am J Ophthalmol, 145, pp.463~471 (2008)[DOI]
- Jabs DA, "Episcleritis and scleritis: clinical features and treatment results", Am J Ophthalmol, 130, pp.469~476 (2000)[DOI]
- Murphy CC, "Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis", Ophthalmology, 111, pp.352~356 (2004)[DOI]