칸디다균에 감염된 침습성 진균 부비동염으로 인한 안와첨증후군
Orbital Apex Syndrome Caused by Invasive Fungal Sinusitis due to Candida glabrata: A Case Report
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목적: 칸디다균에 감염된 침습성 진균 부비동염으로 인한 안와첨증후군을 경험하여 보고하고자 한다. 증례요약: 76세 남성이 3주 전 발생한 좌안 시력저하 및 좌안, 측두부에 이르는 통증을 주소로 내원하였다. 당뇨, 신부전과 협심증을 앓고 있었으며, 1개월 전 COVID-19 확진으로 입원 치료한 이력이 있었다. 조영제를 사용한 안와 전산화 단층 촬영 검사에서 양측 부비동염 및 좌측 시신경을 침범하는 조영증강 병변이 관찰되어 이비인후과에서 내시경 부비동수술을 시행하였고 Gömöri methenamine silver로 염색한 병리조직검사에서 칸디다균 소견, 균배양 검사에서 Candida glabrata 소견을 확인하였다. 이에 amphotericin B 정맥주사를 시행하였고, 이어서 itraconazole 경구약을 투약하였다. 치료 6개월 후 호전되어 퇴원했으나, 안와첨증후군으로 인한 좌안 광각무 및 전체 눈근육마비 소견은 남아있었다. 결론: 칸디다 감염으로 인한 침습성 진균 부비동염은 국제적으로 매우 드물게 보고되었으며, 특히 국내에서는 처음 보고되었다. 염증성 병변이 발생한 경우 안과 파급 가능성을 염두에 두고 균주 특성에 따른 평가 및 치료가 필요하다.
Abstract
Purpose: To report a case of orbital apex syndrome resulting from invasive fungal sinusitis attributed to the unusual Candida glabrata species. Case summary: A 76-year-old patient presented with persistent left-sided orbital pain, headaches, and blurred vision for 3 weeks. The patient had a history of uncontrolled diabetes, chronic kidney failure, and angina, and was treated for a COVID-19 infection 1 month prior to admission. Contrast-enhanced computed tomography scans revealed extensive bilateral sinusitis affecting the left optic nerve. The patient underwent endoscopic sinus surgery, which included nasal cavity biopsy, conducted by an otorhinolaryngologist. Histopathological analysis using Gömöri methenamine silver stains identified Candida. Cultures from sinus specimens later grew Candida glabrata. Treatment involved daily IV amphotericin B followed by oral itraconazole. After 6 months, the patient fully recovered from fungal sinusitis but continued to experience negative light perception in the left eye and progressed to complete ophthalmoplegia, consistent with orbital apex syndrome. Conclusions: Reports of invasive fungal sinusitis caused by Candida infections are rare globally. This report marks the first occurrence in this country. Effective management requires careful assessment and appropriate treatment tailored to the specific species, especially considering the risk of orbital extension of the inflammatory lesion.
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