눈꺼풀처짐을 동반한 위눈꺼풀올림근에 국한된 외안근염 1예
Unilateral Ptosis Due to Isolated Levator Myositis
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목적: 위눈꺼풀올림근을 침범한 외안근염을 경험하였고 이는 드문 것이기에 보고하고자 한다. 증례요약: 27세 남자 환자가 1주일 전부터 발생한 좌안 위눈꺼풀의 발적, 부종 및 압통으로 내원하였다. 환자는 안와 전산화단층촬영상상직근-위눈꺼풀올림근 복합체의 비후소견이 관찰되었으나 모든 방향에서 안구운동은 정상이었고 좌안 위눈꺼풀처짐만이 관찰되었다. 환자는 내원일 이후 3세대 세팔로스포린 주사제를 사용하여 3일간 치료하였으나 증상의 호전이 없었다. 이후 특발성 외안근염으로진단하고 부신 피질 호르몬을 1개월간 경구 투약하였고 위눈꺼풀의 발적, 부종 및 위눈꺼풀처짐은 호전되었다. 결론: 특발성외안근염은 외안근을 침범하는 비특이적인 안와 염증으로 원인이 확실히 규명되어 있지 않지만 면역이상과 관련되어 발생될 수 있다고 알려졌다. 외안근염의 침범부위는 내직근이 가장 흔하며 위눈꺼풀올림근에만 국한되어 발생하는 경우는 매우 드물다. 저자들은 위눈꺼풀올림근에만 발생한 특발성 외안근염을 경험하였기에 보고하며, 눈꺼풀처짐을 동반한 눈꺼풀부종의 감별진단 시 염두에 두어야 할 것으로 생각한다.
Abstract
Purpose: To present a rare case of idiopathic orbital myositis involving levator palpebrae superioris. Case summary: A 27-year-old male presented with a 1-week history of redness, discomfort, swelling, and drooping of his left upper eyelid. A computed tomography scan showed isolated enlargement of the right superior rectus/levator muscle complex. On examination, there was a left blepharoptosis, although eye movements were normal. The authors treated the patient with 3rd-generation cephalosporin; however, after 3 days, the symptoms did not improve. Subsequently, the patient was diagnosed with idiopathic orbital myositis and treated with oral corticosteroids for 1 month; the symptoms gradually resolved. Conclusions: Idiopathic orbital myositis is a subtype of nonspecific orbital inflammation primarily involving the extraocular muscles. Although the exact cause of orbital myositis is unknown, an immune-mediated pathophysiologic mechanism appears to be one of the causes. Medial rectus myositis is the most common, and isolated levator muscle myositis is very rare. The authors of the present study reported a case of orbital myositis involving the levator palpebrae superioris which should be considered a differential diagnosis of blepharoptosis with eyelid swelling.
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