결막 임파종으로 의심된 환자에서 확진된 엡스타인-바바이러스 결막종물 1예
A Case of Conjunctival Mass with Infectious Mononucleosis by EBV
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목적: 상부구 결막의 융기된 병변을 주소로 내원한 8세 환자에서 시행한 조직검사상 엡스타인 바이러스 인코딩 영역(Epstein-Barrvirus encoding region, EBER) 염색 양성소견으로 엡스타인 바이러스가 원인으로 확진된 1예를 보고하고자 한다. 증례요약: 특이병력 없는 8세 남아가 3일 전부터 시작된 우안의 결막 종물로 조직검사을 위해 의뢰되었다. 안과적 검사상 우안 상구부결막의 충혈과 통증을 동반하지 않는 연어색 융기 병변이 있었다. 1일 전부터는 인후통, 열감 소견 보여 본원 소아과에 입원하였었다. 입원 당시 편도 비대소견 있었으며 혈액검사상 백혈구 14960/uL로 증가되어 있었고 EBV PCR 검사와 VCA IgM에서 양성 소견을보여 EBV에 의한 감염성 단핵구증으로 진단하였다. 스테로이드 점안 치료 5일 뒤 병변 호전되지 않아 생검을 시행하였고 림프구침윤과 만성 염증 소견을 보였으며 EBER염색에서 양성소견을 보였다. 결론: 결막에 융기된 듯한 분홍색 종괴의 소견을 보이는 경우 엡스테인-바 바이러스에 의한 병변도 감별진단으로 고려하여 할 것으로생각한다.
Abstract
Purpose: To report a case of conjunctival mass with infectious mononucleosis by Epstein-Barr virus (EBV) confirmed withEpstein-Barr encoding region (EBER) in situ hybridization. Case summary: A 8 year-old male without underlying disease was referred with counjunctival mass on the right eye starting 3days ago. In ophthalmologic evaluation, there was injected, nontender, and “salmon patch” appearance conjunctival lesion onright superior bulbar conjunctiva. The patient was admitted to pediatrics with sore throat and fever. The tonsil were enlarged andwhite blood cell count was 14960/uL. EBV polymerase chain reaction (PCR) test and Viral capsid antigen Immunoglobulin M(VAC IgM) test were positive, the diagnose of infectious mononucleosis by EBV was made. After 5 days steroid eyedrop therapy,biopsy was performed because the lesion was not improved. There were lymphocyte infiltration, chronic inflammation and positivein EBER in situ hybridization. Conclusions: Elevated and pinkish lesion on conjunctiva, EBV lesion should be considered as differential diagnosis.
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