프로프라놀롤 치료를 시행한 유아모세혈관종 1예
A Case of Periorbital Infantile Capillary Hemangioma Treated With Propranolol
1
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
목적: 프로프라놀롤로 치료한 유아모세혈관종 1예를 보고하고자 한다. 증례요약: 6개월 된 여아가 태어나면서부터 발견된 오른쪽 위눈꺼풀의 종괴를 주소로 내원하였다. 종괴는 둥근 지붕 모양에 적자색을 띠고 있었고, 눈꺼풀의 대부분을 침범하고 있었으며 종괴 표면에 나뭇가지 모양의 혈관 주행이 관찰되었다. 종괴로 인하여 처진 위눈 꺼풀은 시축을 반쯤 가리고 있었고, 오른눈의 보기와 따라보기는 좋지 않았다. 이에 우안 약시를 동반한 유아모세혈관종으로 진단하고, 프로프라놀롤 치료를 시작하였다. 2.5개월 치료 이후 혈관종은 부피와 크기가 두드러지게 감소하였고, 색깔은 적자색에서 옅은 붉은색 으로 변하였으며, 경도가 부드러워졌다. 오른눈의 눈꺼풀처짐은 호전되었고, 보기와 따라보기 또한 호전을 보였다. 투약 도중 감기 때문에 이브프로펜을 함께 복용할 때 일시적으로 심전도에서 QTc 연장 소견이 관찰되었던 것 이외에 저혈압, 서맥, 저혈당, 기관지 수축, 간 효소 상승 등의 부작용은 발생하지 않았다. 결론: 눈 주위에 발생한 유아모세혈관종에 대하여 프로프라놀롤 치료를 고려해야 할 것이며, 추후 프로프라놀롤의 장기적 부작용과 합의된 치료 지침에 대한 연구가 필요하다.
Abstract
Purpose: To report a case of periorbital infantile capillary hemangioma treated with propranolol. Case summary: A 6-month-old girl visited our clinic for a mass on the right upper eyelid, which had been present since birth. A dome-shaped, red-purple colored mass occupying almost the entire right upper eyelid was observed, and overlying branch-shaped telangiectases were also detected. The visual axis of the right eye was partially obscured, due to the ptotic eyelid, and her ability to fix and follow was poor in the right eye. The patient was diagnosed with infantile capillary hemagioma. Because amblyopia in her right eye was suspected, treatment with propranolol was initiated. After 2.5 months of propranolol treatment, the hemangioma decreased in size and volume dramatically, changed from red-purple to light red color, and softened. The ptosis of the right upper eyelid improved, as well as the ability of the right eye to fix and follow. No significant adverse effects (e.g. hypotension, bradycardia, hypoglycemia, bronchospasm, or elevated liver enzymes) were observed, except transient QTc prolongation during cotreatment with ibuprofen, due to an upper respiratory infection. Conclusions: Propranolol should be considered as a treatment option for periorbital infantile capillary hemangioma. Further clinical studies are required to establish the optimal guidelines and long-term outcome.
참고문헌 (34)
- Haik BG, "Capillary hemangioma (infantile periocular hemangioma)", Surv Ophthalmol, 38, pp.399~426 (1994)
- Margileth AM, "Cutaneous hemangiomas in children. Diagnosis and conservative management", JAMA, 194, pp.523~526 (1965)
- Ceisler E, "Ophthalmic issues in hemangiomas of infancy", Lymphat Res Biol, 1, pp.321~330 (2003)
- Robb RM, "Refractive errors associated with hemangiomas of the eyelids and orbit in infancy", Am J Ophthalmol, 83, pp.52~58 (1977)
- Sutual FC, "Eyelid necrosis following intralesional corticosteroid injection for capillary hemangioma", Ophthalmic Surg, 18, pp.103~105 (1987)
- Cogen MS, "Eyelid depigmentation following corticosteroid injection for infantile ocular adnexal hemangioma", J Pediatr Ophthalmol Strabismus, 26, pp.35~38 (1989)
- Droste PJ, "Linear subcutaneous fat atrophy after corticosteroid injection of periocular hemangiomas", Am J Ophthalmol, 105, pp.65~69 (1988)
- Shorr N, "Central retinal artery occlusion associated with periocular corticosteroid injection for juvenile hemangioma", Ophthalmic Surg, 17, pp.229~231 (1986)
- Zarem HA, "Induces resolution of cavernous hemangiomas following prednisolone therapy", Plast Reconstr Surg, 39, pp.76~83 (1967)
- Bennett ML, "Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation", Arch Ophthalmol, 137, pp.1208~1213 (2001)
- Ezekowitz RA, "Interferon alfa-2a therapy for life-threatening hemangiomas of infancy", N Engl J Med, 326, pp.1456~1463 (1992)
- Rampini E, "Interferon alpha 2b for treatment of complex cutaneous haemangiomas of infancy: a reduced dosage schedule", Br J Dermatol, 142, pp.189~191 (2000)
- Frieden IJ, "Infantile hemangiomas: current knowledge, future directions: proceedings of a research workshop on infantile hemangiomas", Pediatr Dermatol, 22, pp.383~406 (2005)
- Gorst CM, "Combined treatment of a proliferative periorbital hemangioma with a tunable dye laser and intralesional steroids to prevent deprivation amblyopia", J R Coll Surg Edinb, 46, pp.234~236 (2001)
- Landthaler M, "Laser therapy of childhood haemangiomas", Br J Dermatol, 133, pp.275~281 (1995)
- Ira FB, "The use of transarterial microembolization in the management of hemangiomas of the perioral region", J Oral Maxillofac Surg, 43, pp.239~248 (1985)
- 김병진, "전색술을 이용한 모세혈관종의 수술적 치료", 대한안과학회지, 43(5), pp.805~813 (2002), 대한안과학회
- Walker RS, "Surgical excision of periorbital capillary hemangiomas", Ophthalmology, 101, pp.1333~1340 (1994)
- Aldave AJ, "Surgical excision of selected amblyogenic periorbital capillary hemangiomas", Ophthalmic Surg Lasers, 30, pp.754~757 (1999)
- Leaute-Labreze C, "Propranolol for severe hemangiomas of infancy", N Engl J Med, 358, pp.2649~2651 (2008)
- Fay A, "Propranolol for isolated orbital infantile hemangioma", Arch Ophthalmol, 128, pp.256~258 (2010)
- Taban M, "Propranolol for orbital hemangioma", Ophthalmology, 117, pp.195~ (2010)
- Manunza F, "Propranolol for complicated infantile haemangiomas: a case series of 30 infants", Br J Dermatol, 162, pp.466~468 (2010)
- Zimmermann AP, "Propranolol therapy for infantile haemangiomas: review of the literature", Int J Pediatr Otorhinolaryngol, 74, pp.338~342 (2010)
- Pope E, "Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial", Pediatrics, 119, pp.e1239~1247 (2007)
- Bartoshesky LE, "Corticosteroid treatment of cutaneous hemangiomas: how effective? A report on 24 children", Clin Pediatr (Phila), 17, pp.625~ (1978)
- Weiss AH, "Adrenal suppression after corticosteroid injection of periocular hemangiomas", Am J Ophthalmol, 107, pp.518~522 (1989)
- Glatt HJ, "Adrenal suppression and growth retardation after injection of periocular capillary hemangioma with corticosteroids", Ophthalmic Surg, 22, pp.95~97 (1991)
- Sommers Smith SK, "Beta blockade induces apoptosis in cultured capillary endothelial cells", In Vitro Cell Dev Biol Anim, 38, pp.298~304 (2002)
- Gottschling S, "Two infants with life-threatening diffuse neonatal hemangiomatosis treated with cyclophosphamide", Pediatr Blood Cancer, 46, pp.239~242 (2006)
- Lawley LP, "Propranolol treatment for hemangioma of infancy: risks and recommendations", Pediatr Dermatol, 26, pp.610~614 (2009)
- Sans V, "Propranolol for severe infantile hemangiomas: follow-up report", Pediatrics, 124, pp.e423~431 (2009)
- Farhangi V, "QTc prolongation due to propranolol overdose", Int J Psychiatry Med, 33, pp.201~202 (2003)
- Yao X, "Propranolol inhibits the human ether-a-go-go-related gene potassium channels", Eur J Pharmacol, 519, pp.208~211 (2005)