후부판모양맥락망막염에서의 유리체강내 베바시주멥 선행 치료 후 임상경과
Clinical Course Following Intravitreal Bevacizumab Injection in Posterior Placoid Chorioretinitis
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목적: 잠복매독에 의한 후부판모양맥락망막염에서 유리체강내 bevacizumab 선행 치료 후 경과를 빛간섭단층촬영과 같이 보고하고자한다. 증례요약: 43세 여자환자가 내원 3일 전부터 시작된 우안의 시력 저하를 주소로 내원하였다. 안저에서 우안 황반부에 판모양 맥락망막염이 있었으며 전안부및 유리체에 염증반응은 없었다. 유리체강내 bevacizumab 주사를 시행하면서 전신검사를 시행하였다. 1주일후 안저에서 황반부 병변은 소실되었으나 스펙트럼 영역 빛간섭단층촬영상 광수용체의 이상은 지속되었다. 혈청학적 검사에서 VDRL 과 FTA-ABS 양성 소견을 보였으며 내과 협진에서 잠복매독으로 최종 진단되어 penicillin 근주를 1주일 간격으로 3회를 시행하였다. 그 후 시력과 외망막층 이상은 점차 호전되었으며 6개월간 경과관찰기간 동안 재발은 없었다. 결론: 후부판모양맥락망막염에서 항생제 치료와 함께 유리체강내 bevacizumab 치료를 고려할 수 있으며 질환의 기전에 대해서는 추가 연구가 필요하다.
Abstract
Purpose: To report the clinical course with optical coherence tomography findings following intravitreal bevacizumab injection in patients with posterior placoid chorioretinitis due to latent syphilis. Case summary: A 43-year-old woman presented with visual dimness in the right eye 3 days in duration. Fundus examination showed yellow, placoid lesions in the right eye and there was no cell reaction in the anterior chamber and vitreous. An intravitreal bevacizumab injection was given and systemic work-up performed. After 1 week, the macular lesion disappeared. However,photoreceptor disarrangement was present on spectral-domain optical coherence tomography image. On serologic test,the Venereal Disease Research Laboratory test, and fluorescent treponemal antigen absorption test were positive. She was referred to a division of infectious diseases and confirmed as latent syphilis. The patient received intramuscular penicillin 3 times weekly. Visual acuity and outer retinal abnormality further improved and there was no recurrence during the 6-month follow-up. Conclusions: Intravitreal bevacizumab injection added to antibiotic treatment may be considered for treating patients with posterior placoid chorioretinitis. Further studies are necessary to evaluate precise disease mechanisms and treatment.
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