동안신경마비를 동반한 안와 국균증 1예
A Case of the Third Nerve Palsy in a Patient with Orbital Aspergillosis
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목적: 좌안 동안신경마비를 동반한 안와 국균증 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 75세 남자 환자가 좌안의 급격한 시력저하, 안구움직임장애, 안검하수를 주소로 내원하였다. 내원 2개월 전 이비인후과에서비성이 나는 증상과 두통을 주소로 부비동염으로 진단받고 경구 항생제를 7일간 복용한 과거력이 있었다. 안와 자기공명영상 촬영영상에서 좌측 비강내, 벌집뼈, 좌측 안와의 골침식을 동반하는 종괴가 관찰되었다. 이비인후과에서 내시경 부비동수술과 좌측 안와감압수술을 시행하여 종괴를 제거하였고 종괴의 병리조직검사에서 아스페르길루스 진균이 관찰되었다. 이후 7일간 Amphotericin B정맥주입과 Voriconazole 경구 투여를 시행하였다. 경과관찰 중 재발 소견은 없었으며 안구움직임장애와 안검하수는 회복되는 양상을보였다. 결론: 본 증례를 통하여, 안와 국균증 환자에서 시력 저하와 함께 동안 신경 마비가 동시에 발생할 수 있음을 알 수 있었다.
Abstract
Purpose: To report a case of orbital aspergillosis with third nerve palsy. Case summary: A 75-year-old male presented with abrupt onset of visual impairment, extraocular movement limitation,and ptosis. The patient previously experienced rhinolalia and headache and was diagnosed with sinusitis 2 months prior,and was treated with oral antibiotics for 1 week. Orbital magnetic resonance imaging revealed a mass with bone erosion includingthe nasal cavity, ethmoid bone, and left orbit suggestive of fugal sinusitis. Aspergillus was detected histopathologicallyin the mass which was removed by endoscopic surgery. Amphotericin B was administered intravenously for 7 daysalong with voriconazole. There was no recurrence during the follow-up period. Extraocular movement limitations and ptosiswere recovered postoperatively. Conclusions: The present study results indicate that visual impairment and third nerve palsy can develop in a patient withorbital aspergillosis.
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