바이러스뇌수막염과 연관된 급성망막괴사 증례보고 2예
Two Cases of Acute Retinal Necrosis after Viral Meningitis
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목적: 바이러스뇌수막염 후 발생한 급성망막괴사 2예를 보고하고자 한다. 증례요약: 3주 전 바이러스뇌수막염으로 치료 받은 52세 여자가, 3일 전 발생한 우안 시력저하를 주소로 내원하였다. 내원 당시 우안결막 충혈, 전방 내 염증세포 2+, 유리체의 염증 소견이 관찰되었다. 안저검사상 우안 망막 주변부에 다수의 황백색 침윤이 관찰되었고, 형광안저혈관조영 결과 초기 망막 주변부 저형광 반점과 후기 혈관누출을 보였다. 급성망막괴사 진단하 Acyclovir (2,100 mg/day) 정맥 주사 치료를 시행하였다. 치료 중 망막 주변부 병변은 점차 호전되었으나, 이후 우안에 이차적인 망막박리 발생으로 유리체 절제술 시행 후 안정적으로 유지 중이다. 1달 전 후두부 두통, 어지럼증, 구역, 구토로 바이러스뇌수막염 의증으로 신경과 입원치료를 받은 57세 남자가 3일 전부터 우안 시력저하가 있어 내원하였다. 안저검사상 망막 주변부 염증세포 침윤 소견, 형광안저혈관조영 결과 후기 망막 주변부 혈관 누출, 전신검사에서 Herpes simplex virus와 Cytomegalovirus의 immunoglobulin G 양성 소견을 보였다. 급성망막괴사 진단하 Acyclovir (2,100 mg/day) 정맥 주사 치료를 시행하였고 그 후 안정적인 망막 상태를 보이고 있다. 결론: 바이러스성 뇌염에 반해 바이러스뇌수막염의 이환과 연관한 급성망막괴사는 그 예가 드물다. 뇌수막염 발병 이후 급성망막괴사가 발생할 수 있으므로, 뇌수막염 과거력이 있는 환자를 진료할 때 급성망막괴사의 가능성을 염두에 두어야 할 것이다.
Abstract
Purpose: To report two cases of acute retinal necrosis following viral meningitis. Case summary: A 52-year-old woman who has had viral meningitis presented with visual loss of right eye. Slit-lamp examination showed conjunctival injection and inflammatory cells (2+) in the anterior chamber of the right eye. Funduscopic examination showed multiple yellow-whitish spots in the peripheral retina. Fluorescein fundus angiography showed early hypofluorescence and the late vascular leak in the peripheral retina. After the patient was diagnosed with Acute retinal necrosis (ARN), intravenous acyclovir (2,100 mg/m2/day) was administered. During the treatment period, the retinal detachment of the right eye was found, so the authors performed pars plana vitrectomy. After the surgery, new retinal lesions weren’t observed in both eyes during follow-up. A 57-year-old man previously treated with possible viral meningitis presented with visual loss of his right eye. Funduscopic examination showed multiple yellow-whitish spots in the peripheral retina. Fluorescein fundus angiography showed the late vascular leak in the peripheral retina. In the systemic evaluation, Herpes simplex virus and Cytomegalovirus immunoglobulin G were detected. With the impression of ARN, intravenous acyclovir (2,100 mg/m2/day) was administered. No new retinal lesions were observed in both eyes during follow-up. Conclusions: We report rare cases of ARN occurring after viral meningitis. Uveitis in patients with recent history of meningitis should be examined carefully under the suspicion of ARN.
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