농포건선 환자에서 발생한 주변부궤양각막염 및 공막염 1예
A Case of Peripheral Ulcerative Keratitis and Scleritis in a Patient with Pustular Psoriasis
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목적: 농포건선에 동반되는 주변부궤양각막염 및 공막염의 임상양상 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 62세 남자 환자가 수일 전부터 시작된 우안의 통증 및 손발의 무균성 농포 병변을 주소로 내원하였다. 내원 시 최대교정시력은 우안 0.5, 좌안 0.7이었고, 시행한 세극등현미경검사상 우안의 각막부종과 미란 및 궤양을 동반한 주변부 각막침윤소견이 있었으나전방내 염증소견은 보이지 않았다. 손의 피부 병변에 대한 조직 검사 결과에서 농포건선으로 진단되었다. 국소 항생제 및 스테로이드와 더불어 경구 스테로이드 치료를 시행한 결과, 병변이 호전되는 소견을 보여 경구 스테로이드 치료를 중단하였다. 내원 1개월째좌안에 새로운 공막충혈과 염증이 발생하여 양안에 대해 국소 및 전신 스테로이드 치료를 병행하였다. 내원 2개월째 환자의 증상은호전되었고, 시력검사상 시력은 양안 1.0이었으며 검사상 우안에서 경도의 주변부 각막혼탁이 관찰되었으나 양안 모두 염증이 호전된소견을 보였다. 결론: 본 증례에서와 같이 농포건선 환자에서 안과적 소견으로 주변부 각막침윤 및 궤양, 공막염 등을 동반할 수 있음을 염두에 두어야하며, 이 경우 국소 및 전신 스테로이드 치료가 필요하다.
Abstract
Purpose: To report a case of peripheral ulcerative keratitis and scleritis in a patient with pustular psoriasis. Case summary: A 62-year-old male presented with skin lesions on the hands and feet and pain in the right eye, which started afew days prior. Corrected visual acuity was 0.5 in the right eye and 0.7 in the left eye at initial visit. Corneal edema, erosion, ulcerand peripheral corneal infiltration of the right eye were observed. However, anterior chamber reaction was not observed. Histological analysis of hand skin lesions indicated pustular psoriasis. The patient was initially treated with topical antibiotics anda combined therapy of oral and topical steroids for ocular symptoms. As a result, the right eye showed slight improvement andthe oral steroid was discontinued. One month after the initial visit, scleritis appeared on the left eye and topical and oral steroidswere restarted for both eyes. Two months after the initial visit, ocular symptoms were improved significantly and corrected visualacuity was 1.0 in both eyes. The mild peripheral corneal opacity remained in the right eye, but the previous inflammations in botheyes were improved. Conclusions: As shown in this case, possibility of peripheral corneal infiltration, corneal ulcer and scleritis should be consideredin patients with pustular psoriasis and topical and systemic steroids should be administered if accompanying ocular manifestationsoccur.
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