단안 시신경염으로 발현한 눈톡소플라즈마증 1예
Presumed Ocular Toxoplasmosis Presenting as Isolated Unilateral Papillitis
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 단안의 시신경염으로 발현하였으나 혈청학적 검사에서 눈톡소플라즈마증으로 진단하여 성공적으로 치료한 드문 경우를 경험하였기에 이를 보고하고자 한다. 증례요약: 53세 여성이 1주 전부터 시작된 우안 시력저하를 주소로 내원하였다. 초진 시력은 우안 0.8, 좌안 1.0 이었고, 전안부는 정상이었으며, 안저검사에서 우안의 시신경유두부종과 시신경유두주위 경성삼출물 소견을 보였다. 형광안저촬영에서 우안 시신경유두의형광누출이 있었으나, 혈관염이나 맥락망막염 소견을 보이지는 않았다. 동공반응검사와 색각검사는 정상이었으나, 시야검사에서 우안중심암점, 빛간섭단층촬영에서 우안 시신경유두부종이 있었다. 면역혈청검사에서 toxoplasma IgM과 IgG가 양성이어서 눈톡소플라즈마증 진단 하에 경구 스테로이드와 항생제 치료를 시작하였다. 치료 2달 후 양안 교정시력은 각각 1.0 이고, 시야검사에서 중심암점이소실되었으며, 빛간섭단층촬영에서도 시신경부종은 호전되었다. 결론: 눈톡소플라즈마증은 드물지만 맥락망막염을 동반하지 않고 시신경염 단독 형태로도 발현할 수 있으므로, 철저한 혈청학적 검사및 적절한 항생제와 스테로이드 치료가 필요하다.
Abstract
Purpose: To report an atypical case of ocular toxoplasmosis presenting as isolated unilateral papillitis. Case summary: A 53-year-old female presented with visual difficulty in her right eye that had begun 1 week previously. Best corrected visual acuity was 0.8 in the right eye and 1.0 in the left eye. On fundoscopic examination, optic disc swelling and focal edema with hard exudates in the nasal parapapillary retina were found in her right eye. Fluorescein angiography revealed marked leakage of dye from the swollen optic disc. There was no evidence of vasculitis and chorioretinitis. Pupillary light reflex and color vision were normal. Visual field (VF) showed generalized reduction in the right eye, and was normal in the left eye. Optical coherence tomography (OCT) revealed right optic disc swelling. Serology was positive for toxoplasma IgM and IgG. The patient was treated with oral steroids and antitoxoplasma antibiotics. Two months later, visual acuity was 1.0 in the right eye. There was no disc swelling on fundoscopy or OCT and VF was normal. Conclusions: Ocular toxoplasmosis can present atypically as isolated papillitis without chorioretinitis and mimic idiopathic optic neuritis. A thorough serologic examination for toxoplasmosis along with proper treatment should be performed.
참고문헌 (16)
- Holland GN, "Ocular toxoplasmosis: a global reassessment. Part I: epidemiology and course of disease", Am J Ophthalmol, 136, pp.973~988 (2003)
- Atmaca LS, "Clinical features and prognosis in ocular toxoplasmosis", Jpn J Ophthalmol, 48, pp.386~391 (2004)
- Biswas J, "Pattern uveitis in a referral uveitis clinic in India", Int Ophthalmol, 20, pp.223~228 (1996)
- Holland GN, "Ocular toxoplasmosis; a global assessment part II: disease manifestations and management", Am J Ophthalmol, 137, pp.1~17 (2004)
- Tandon R, "Toxoplasmic papillitis with central retinal artery occlusion", Can J Ophthalmol, 30, pp.374~376 (1995)
- Song A, "Atypical anterior optic neuropathy caused by toxoplasmosis", Am J Ophthalmol, 133, pp.162~164 (2002)
- Wong R, "Toxoplasma gondii: an atypical presentation of toxoplasma as optic disc swelling and hemispherical retinal vein occlusion treated with intravitreal clindamycin", Int Ophthalmol, 29, pp.195~198 (2009)
- Lee M, "Optic nerve toxoplasmosis and orbital inflammation as initial presentation of AIDS", Graefes Arch Clin Exp Ophthalmol, 244, pp.1542~1544 (2006)
- Folk JC, "Presumed Toxoplasmic papillitis", Ophthalmology, 91, pp.64~67 (1984)
- Shenoy R, "Presumed ocular toxoplasmosis presenting as papillitis", Indian J Ophthalmol, 51, pp.357~359 (2003)
- Sanderfeld L, "Bilateral papillitis in ocular toxoplsmosis", Eye (Lond), 24, pp.188~189 (2010)
- Alipanahi R, "Acute papillitis in young female with toxoplasmosis", Middle East Afr J Ophthalmol, 18, pp.249~251 (2011)
- Lee DC, "A case of congenital toxoplasmosis in the neonate", J Korean Ophthalmol Soc, 40, pp.1415~1420 (1999)
- 박수연, "톡소플라스마 망맥락막염에서 유리체강내 클린다마이신 주입술", 대한안과학회지, 53(7), pp.1046~1052 (2012), 대한안과학회
- Eckert GU, "Optic nerve changes in ocular toxoplasmosis", Eye (Lond), 21, pp.746~751 (2007)
- Dubey JP, "Biological and genetic characterisation of Toxoplasma gondii isolates from chickens from Sao Paulo, Brazil: unexpected findings", Int J Parasitol, 32, pp.99~105 (2002)