유리체강내 간시클로버와 포스카네트 병합 치료로 호전된 진행성외망막괴사 1예
A Case of Progressive Outer Retinal Necrosis Treated by Combined Intravitreal Foscarnet and Ganciclovir
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목적: 저자들은 급성백혈병 환자에서 발생한 진행성외망막괴사가 유리체강내 항바이러스제 병합치료로 호전된 증례를 보고하고자한다. 증례요약: T 전구세포 백혈병으로 진단 받고 항암 치료 및 제대혈 조혈모세포이식을 시행 받은 11세 남자 환자에서 이마의 대상포진과우안 망막 주변부 괴사성 병변이 발생하고 빠르게 진행하였다. 환아의 뇌척수액에서 Varicella-Zoster virus가 검출되었으며 진행성외망막괴사로 진단되었다. 정맥내 acyclovir 및 foscarnet과 우안 유리체강내 foscarnet 주사치료에도 망막괴사는 진행하여 망막박리가발생하고 전체 망막괴사로 발전하였다. 이후 좌안에 새로운 망막괴사가 발견되어 정맥내 foscarnet, ganciclovir와 유리체강내foscarnet, ganciclovir 주사치료를 시행하였으며, 망막박리가 발생하였으나 망막괴사는 억제되어 후극부를 침범하지 않았다. 이후경구 valganciclovir와 유리체강내 foscarnet, ganciclovir 주사치료를 유지하며 좌안 시력을 보존하였다.
Abstract
Purpose: To report a case of progressive outer retinal necrosis treated by combined intravitreal foscarnet and ganciclovir. Case summary: A 11-year-old male with a history of chemotherapy and cord blood transplantation due to precursor T-cell leukemia developed Herpes zoster lesion on his forehead and rapidly progressing peripheral retinal necrosis without vasculitis in the right eye. Varicella-Zoster virus was confirmed in his cerebrospinal fluid using polymerase chain reaction (PCR); and the patient was diagnosed with progressive outer retinal necrosis. Despite combined treatment with intravenous acyclovir and foscarnet and intravitreal foscarnet, retinal necrosis progressed to retinal detachment and total retinal necrosis. During follow-up, new retinal necrosis was observed in his left eye. The patient was started on combined intravenous and intravitreal foscarnet and ganciclovir; retinal necrosis in the left eye regressed and posterior pole was spared. With subsequent oral valganciclovir and intravitreal foscarnet and ganciclovir, the remaining retina was preserved with maintained vision.
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