헤르페스 뇌염 후 발생한 급성망막괴사 증례보고 1예
A Case of Acute Retinal Necrosis Following Herpes Simplex Virus (HSV) Encephalitis
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목적: 헤르페스 뇌염 후 발생한 급성망막괴사 환자 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 이전에 헤르페스 뇌염으로 진단받고 경과 관찰해오던 19세 남자가 최근 두통을 동반한 좌안의 시력 저하를 호소하며 내원하였다. 내원 당시 세극등 검사상 좌안 결막 충혈 소견과 전방내 염증세포가 3+소견 보였다. 안저 검사상 좌안은 유두 부종, 주변부망막에 황백색 반점이 다수 관찰됨과 동시에 혈관 초형성이 관찰되었다. 환자는 임상증상에 의하여 급성망막괴사로 진단받고 입원하여 acyclovir (1500 mg/m2/day) 정맥주사를 시행하였다. 치료 기간 중 망막 박리 및 다수의 망막 열공이 관찰이 되었고, 이후 병변이안정화 되어 열공 주위에 방책레이저치료를 시행하였다. 그 후 현재까지 우안은 망막 괴사 소견 보이지 않고 있고, 좌안은 더 이상새로운 병변으로 진행되지 않고 증상은 호전되었다. 결론: 본 저자들은 국내에서 처음으로 헤르페스 뇌염 후 발생한 급성 망막괴사 환자를 보고함으로써 안과의사는 과거력에서 헤르페스뇌염을 진단받은 적이 있는 환자들에게서는 급성망막괴사가 발생할 수 있음을 염두에 두고 면밀히 진료하고 추적관찰 하여야 할 것이다.
Abstract
Purpose: To report a case of unilateral acute retinal necrosis (ARN) following herpes simplex virus (HSV) encephalitis. Case summary: A 19-year-old man previously diagnosed with HSV encephalitis presented with a headache and visual loss in his left eye. On the initial visit, slit-lamp examination showed conjunctival injection and inflammatory cells (3+) in the anterior chamber of the left eye. Funduscopic examination showed optic disc swelling, multiple yellow-whitish spots in the peripheral retina and retinal vascular sheathing. After the patient was diagnosed with ARN, intravenous acyclovir (1,500mg/m2/day) was administered. Because retinal detachment and multiple retinal breaks were found during the treatment period, the authors performed barrier laser treatment in the peripheral retina. At that time, no retinal necrosis was observed in the patient’s right eye. The retinal lesions regressed, and no new retinal lesion was observed in the left eye, during the follow-up period. Conclusions: We report a case of ARN in a patient with HSV encephalitis. Ophthamologist should perform a thorough ophthalmic examination in a patient diagnosed with HSV encephalitis.
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