급격한 시력저하를 동반한 특발안와근염의 수술적 진단 및 치료 1예
A Case of Surgical Diagnosis and Treatment of Idiopathic Orbital Myositis with Sudden Vision Loss
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목적: 급격히 진행하는 시력저하와 비특이적으로 외직근 첨부 비대를 보이는 환자에서 안와생검을 시행하여 특발안와근염을 진단하고, 부신피질호르몬 정맥주사로 치료한 증례를 보고하고자 한다. 증례요약: 2주 전부터 발생한 왼눈 시력저하를 주소로 20세 여자 환자가 내원하였다. 최대교정 시력은 왼눈 0.2였으며, 교대프리즘가림검사상 왼눈 40프리즘디옵터 내사시가 관찰되었다. 자기공명영상에서 왼눈 외직근 첨부의 둥근 형태 비대와 시신경 압박을 확인하였고, 안와림프종 및 안와생검이 필요한 질환의 감별을 위해 안와생검을 계획하였다. 3주 후 입원 당시 왼눈 최대교정시력 0.02로 악화되었고, 재촬영한 자기공명영상에서 왼눈 직근 모두의 비대를 보였다. 안와생검결과 림프구가 근섬유를 침범하는 소견으로 외안근염을 진단할 수 있었다. 고용량 부신피질호르몬 정맥주사 시행 2주 후 왼눈 최대교정시력은 0.63으로 호전되었고, 내사시는 소실되었으며 자기공명영상에서 왼눈 직근의 비대는 호전되었다. 결론: 안와첨부에 위치하고 단기간에 다발성으로 외안근의 크기가 커지는 비특이적 특발안와근염의 경우 급격한 시력저하가 나타날 수 있으므로 안와생검 전에 고용량 부신피질호르몬 치료를 병행하는 것이 시력 회복에 도움이 된다.
Abstract
Purpose: We report a case of idiopathic orbital myositis with sudden onset of unilateral visual loss and hypertrophy of the lateral rectus muscle at the apex of the orbit that was diagnosed using orbital biopsy and treated with intravenous corticosteroids. Case summary: We examined a 20-year-old woman who complained of decreased visual acuity and binocular diplopia for 2 weeks. She showed 40-prism diopter left esotropia at the primary position. Her visual acuity with eyeglasses was 0.7 and 0.2 in the right and left eyes, respectively. Brain magnetic resonance imaging (MRI) revealed a round mass on the left lateral rectus muscle at the apex of the orbit with optic nerve compression. We planned orbital biopsy to exclude orbital lymphoma and other biopsy-requiring diseases. After 3 weeks, the visual acuity of her left eye decreased to 0.02. Repeated MRI revealed enlargement of all extraocular muscles on the left orbit. With biopsy showing several lymphocytes infiltrating muscle fibers, we made a diagnosis of idiopathic orbital myositis. Intravenous injection of corticosteroids was administered during hospitalization. After 2 weeks of corticosteroid therapy, the visual acuity of her left eye was improved to 0.63, the esotropia disappeared, and the enlargement of the left lateral rectus muscle was improved on orbital MRI. Conclusions: For non-specific idiopathic orbital myositis located at the apex of the orbit and enlargement of the extraocular muscle in a short period with decreased visual acuity, administration of intravenous injection of corticosteroids before orbital biopsy could help restore vision.
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