건강한 소아에서 발생한 급성망막괴사 1예
A Case of Acute Retinal Necrosis in Healthy Childhood
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 건강한 소아에서 발생한 급성망막괴사 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 6세 소아 환자가 좌안 결막 충혈 및 시력저하를 호소하며 내원하였다. 내원 당시 세극등 검사에서 좌안 결막 충혈 및 전방내 염증세포가 4+ 관찰되었으며 안저 검사상 좌안 유두 부종 소견이 보였다. 이에 포도막염 의심하에 prednisolone 30 mg 및 1% prednisolone acetate (Predforte®)를 사용하였으나 2일 후 증상 호전이 없었으며 안저 검사상 급격히 주변부 망막괴사 및 혈관염, 유리체 염증 등의 소견을 보여 급성망막괴사를 진단하고 전방천자 PCR 검사를 시행하였다. PCR 검사상 단순포진 바이러스(HSV) type 2가 검출되었고 Acyclovir 정맥주사를 시행하여 치료하였다. 치료 2달 후 망막 병변의 활동성 병변은 없어지고 호전되었다. 결론: 소아에서 드물게 발생하는 급성망막괴사를 전방천자를 통한 PCR 검사를 이용하여 원인 바이러스를 확인 후 적절한 항바이러스제 정맥주사로 성공적으로 치료하였다. 소아에서 급성망막괴사가 의심된다면 전방천자를 통한 PCR 검사를 시행하여 원인 바이러스를 확인하는 것이 치료에 도움이 될 수 있을 것으로 생각된다.
Abstract
Purpose: To describe a case of acute retinal necrosis (ARN) in childhood. Case summary: A 6-year-old child visited our clinic complaining of conjunctival injection and decreased visual acuity in the left eye. Slit-lamp examination showed conjunctival injection, inflammatory cells (4+) in the anterior chamber, and keratic precipitates. Fundus examination showed disc swelling. The patient was treated with 30 mg of oral prednisolone and 1% prednisolone acetate with the suspicion of uveitis. After 2 days, retinal examination showed a peripheral multifocal yellowish patch and retinal hemorrhage. Herpes simplex virus-2 was detected using polymerase chain reaction (PCR) analysis of the aqueous humor, which was obtained by anterior chamber paracentesis. In the present case, ARN in childhood was successfully treated with intravenous acyclovir. Conclusions: We report a case of ARN in childhood diagnosed using PCR. Intravenous acyclovir may be an effective therapy in children with ARN. Ophthalmologists should promptly perform PCR analysis in patients diagnosed with ARN.
참고문헌 (16)
- Holland GN., "Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society", Am J Ophthalmol, 117, pp.663~667 (1994)
- Rungger-Brändle E., "Bilateral acute retinal necrosis (BARN). Identification of the presumed infectious agent", Ophthalmology, 91, pp.1648~1658 (1984)
- Urayama A., "Unilateral acute uveitis with retinal periarteritis and detachment", Jpn J Clin Ophthalmol, 25, pp.607~619 (1971)
- Silva RA., "Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population : case series and review", Graefes Arch Clin Exp Ophthalmol, 251, pp.559~566 (2013)
- Cottet L., "HSV2 acute retinal necrosis : diagnosis and monitoring with quantitative polymerase chain reaction", Int Ophthalmol, 29, pp.199~201 (2009)
- Flaxel CJ., "Combination systemic and intravitreal antiviral therapy in the management of acute retinal necrosis syndrome(an American Ophthalmological Society thesis)", Trans Am Ophthalmol Soc, 111, pp.133~144 (2013)
- Lau CH., "Acute retinal necrosis features, management, and outcomes", Ophthalmology, 114, pp.756~762 (2007)
- Freeman WR., "A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome", Am J Ophthalmol, 97, pp.133~142 (1984)
- Culbertson WW., "The acute retinal necrosis syndrome. Part 2: histopathology and etiology", Ophthalmology, 89, pp.1317~1325 (1982)
- Lewis ML., "Herpes simplex virus type 1. A cause of the acute retinal necrosis syndrome", Ophthalmology, 96, pp.875~878 (1989)
- Green LK., "Herpes simplex ocular inflammatory disease", Int Ophthalmol Clin, 46, pp.27~37 (2006)
- Van Gelder RN., "Herpes simplex virus type 2 as a cause of acute retinal necrosis syndrome in young patients", Ophthalmology, 108, pp.869~876 (2001)
- Ganatra JB., "Viral causes of the acute retinal necrosis syndrome", Am J Ophthalmol, 129, pp.166~172 (2000)
- Grose C, "Acute retinal necrosis caused by herpes simplex virus type 2 in children : reactivation of an undiagnosed latent neonatal herpes infection", Semin Pediatr Neurol, 19, pp.115~118 (2012)
- 안태수, "헤르페스 뇌염 후 발생한 급성망막괴사 증례보고 1예", 대한안과학회지, 53(8), pp.1186~1189 (2012), 대한안과학회[DOI]
- Silva RA., "Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population : case series and review", Graefes Arch Clin Exp Ophthalmol, 251, pp.559~566 (2013)