매독에 동반된 양안 긴장동공의 치료
Treatment of Bilateral Tonic Pupil Associated with Syphilis
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목적: 매독 환자에서 발현된 양안의 긴장동공이 매독 치료 후 부분적인 호전을 보인 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 27세 남자가 2개월 전부터 시작된 근거리 시력저하를 주소로 내원하였다. 양안의 동공크기는 실내등을 껐을 때 우안 5.5 mm, 좌안 6.5 mm, 실내등을 켰을 때 우안 5.3 mm, 좌안 6.1 mm였으며 동공반응은 대광-근접반사해리를 보이며 근거리 주시 때 느린 동공의 수축과 확대, 그리고 0.0625% 필로카르핀 점안 후 양안의 동공이 축동되었다. 혈청검사상 매독이 확진되었다. Benzathine penicillin G를 근주하고 2개월 경과 후 주관적인 근거리 시력저하 증상이 호전되었으며, 동공크기는 실내등을 껐을 때 우안 5.9 mm, 좌안 6.4 mm, 실내등을 켰을 때 우안 4.8 mm, 좌안 5.3 mm로 일부 호전되었고, 양안 대광반사도 부분적으로 호전되었다. 결론: 양안 긴장동공 관찰 시 혈청검사를 통해 매독 여부를 확인해야 하며, 조기에 적절한 항생제를 투여하면 긴장동공의 상대적으로 빠른 회복을 기대할 수 있다.
Abstract
Purpose: We report a case of a male with bilateral tonic pupils associated with syphilis, that partially improved after syphilis treatment. Case summary: A 27-year-old male presented with a 2-month history of near vision impairment. The right and left pupils were 5.5 mm and 6.5 mm in diameter, respectively, in the dark and 5.3 mm and 6.1 mm, respectively, in the light. Both pupils demonstrated light-near dissociation, slow constriction and redilation when looking at near, and constriction after instillation of 0.0625% pilocarpine. Serological tests were positive for syphilis, while cerebrospinal fluid testing was negative. Two months after treatment with intramuscular injection of benzathine penicillin G, his near vision subjectively improved and the right and left pupils were 5.9 mm and 6.4 mm, respectively, in the dark and 4.8 mm and 5.3 mm, respectively, in the light. The size of both pupils decreased and the pupillary light responses partially improved in both eyes. Conclusions: Patients with bilateral tonic pupils should have serological tests for syphilis. Recovery of tonic pupils can be expected after early treatment with effective antibiotics.
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