양측 안와종괴로 발현한 안와결핵 1예
A Case of Bilateral Orbital Tuberculosis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 안과 영역에서 결핵은 결막결절이나 포도막염 형태로 흔히 나타나며 안와의 감염은 매우 드물다. 저자들은 양측 안와에 발생한 종괴에서 결핵을 진단하여 이를 보고하고자 한다. 증례요약: 64세 남성이 복시를 주소로 내원하였다. 과거력상 당뇨와 고혈압, 만성폐쇄성폐질환의 병력이 있었다. 양안의 교정시력은 1.0, 안압은 16 mmHg였으며, 양안에 안구돌출이 있었고, 양안 모두 하측 안와에서 종괴가 촉진되었다. 안와 컴퓨터단층촬영상, 근원추 바깥쪽에서 안구를 전체적으로 불규칙하게 둘러싸는 경계가 불명확한 종괴가 양안 모두에서 관찰되었다. 국소마취하에 양안에서 종양의 절개생검을 시행하였으며 병리조직검사상 건락괴사가 동반된 만성 육아종성 염증이 관찰되어 양안 안와 결핵으로 진단하였다. 호흡기내과에 전원하여 Isonizid, Rifampin, Ethambutol 3제 요법으로 치료를 12개월간 유지하여 종괴는 완전히 소실되었으며 치료 종료 12개월 후까지 재발이나 합병증은 없었다. 결론: 양안 안와에 발생한 종괴에서 결핵을 진단하고 치료하였으며 안와 결핵은 국내에 보고된 바 없기에 이를 보고하는 바이다.
Abstract
Purpose: Periocular tuberculosis is common in the form of conjunctival tuberculosis or uveitis; however, orbital tuberculosis is very rare. We report a case of tuberculosis diagnosed based on bilateral orbital masses. Case summary: A 64-year-old male with a history of diabetes, hypertension, and chronic obstructive pulmonary disease presented with diplopia. His best-corrected visual acuity was 1.0, and intraocular pressure was 16 mmHg in both eyes. Bilateral proptosis was noted, and inferior orbital masses were palpated in both eyes. On orbital computed tomography, irregular masses were surrounding both globes in the extraconal space. Incisional biopsy of the bilateral orbital masses was performed under local anesthesia. Pathologic examination revealed chronic granulomatous inflammation accompanied by caseous necrosis. The patient was diagnosed with bilateral orbital tuberculosis and underwent triple therapy with isoniazid, rifampin, and ethambutol for 12 months. The orbital masses completely resolved, and there was no recurrence or complication through 12 months after treatment. Conclusions: To our knowledge, bilateral orbital tuberculosis has not been reported yet. Herein, we report a case of orbital tuberculosis presenting as bilateral orbital masses.
참고문헌 (25)
- Ahn JH, "A case of tuberculosis of lid", J Korean Ophthalmol Soc, 37, pp.1293~1297 (1996)
- Khalil M, "Tuberculosis of the orbit", Ophthalmology, 92, pp.1624~1627 (1985)
- Agrawal PK, "Orbital involvement in tuberculosis", Indian J Ophthalmol, 25, pp.12~16 (1977)
- Madge SN, "Orbital tuberculosis:a review of the literature", Orbit, 27, pp.267~277 (2008)
- Mohammad AENA, "Tuberculosis of the orbit and lacrimal gland", Orbit, 11, pp.199~204 (1992)
- Sen DK, "Tuberculosis of the orbit and lacrimal gland: a clinical study of 14 cases", J Pediatr Ophthalmol Strabismus, 17, pp.232~238 (1980)
- Sivaraju L, "Fronto-orbital tuberculous osteomyelitis with temporalis myositis", Orbit, 35, pp.161~162 (2016)
- Dalvin LA, "Orbital and external ocular manifestations of Mycobacterium tuberculosis: A review of the literature", J Clin Tuberc Other Mycobact Dis, 4, pp.50~57 (2016)
- Choi HY, "Ophthalmic Plastic and Reconstructive Surgery" (2015), Naewae Haksool
- Pillai S, "Orbital tuberculosis", Ophthal Plast Reconstr Surg, 11, pp.27~31 (1995)
- Narula MK, "Pictorial essay: Orbital tuberculosis", Indian J Radiol Imaging, 20, pp.6~10 (2010)
- Sharma A, "Tuberculosis of the lacrimal gland: a case report", J Pediatr Ophthalmol Strabismus, 35, pp.237~239 (1998)
- MacFaul PA, "System of Ophthalmology, Vol. 13:The Ocular Adnea: Part 2: Lacrimal, Orbital and Para-Orbital Diseases", pp.902~905 (1974), Henry Kimpton
- Dewan T, "Orbital tuberculoma extending into the cranium", Ophthalmologica, 220, pp.137~139 (2006)
- Tuli N, "Orbital tuberculosis in childhood with intracranial extension:a case report", Cases J, 3, pp.38~ (2010)
- 2015 Global Tuberculosis Report, "World Health Organization", WHO, 157~192 (2015)
- Hong YP, "The seventh nationwide tuberculosis prevalence survey in Korea, 1995", Int J Tuberc Lung Dis, 2, pp.27~36 (1998)
- Banait S, "Orbital tuberculosis manifesting as proptosis in an immunocompromised host", Indian J Sex Transm Dis, 33, pp.128~130 (2012)
- Park TK, "A study on Tuberculin in an Urban Primary School", Korean J Prev Med, 6, pp.119~132 (1973)
- Kaur A, "Orbital tuberculosis-an interesting case report", Int Ophthalmol, 26, pp.107~109 (2005)
- Patkar S, "Intraorbital extraocular tuberculosis:a report of three cases", Surg Neurol, 42, pp.320~321 (1994)
- Tay E, "Idiopathic orbital inflammation with extensive intra-and extracranial extension presenting as 6th nerve palsy--A case report and literature review", Orbit, 27, pp.458~461 (2008)
- Sheu SJ, "Ocular manifestations of tuberculosis", Ophthalmology, 108, pp.1580~1585 (2001)
- Litvinov AV, "Historical reference: giant multinuclear cells in tubercular granuloma", Probl Tuberk Bolezn Legk, (11), pp.59~61 (2005)
- Kotake S, "Polymerase chain reaction for the detection of Mycobacterium tuberculosis in ocular tuberculosis", Am J Ophthalmol, 117, pp.805~806 (1994)