중심망막동맥 폐쇄로 인한 갑작스런 시력저하가 첫 증상으로 나타난 결절다발동맥염 1예
A Case of Polyarteritis Nodosa with Decreased Vision as a First Symptom
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목적: 결절다발동맥염은 눈 조직을 포함하여 몸 전체의 중간, 작은 크기의 동맥에 이환되는 괴사성 혈관염이다. 저자들은 결절다발동맥염을 진단 받기 전 선행한 환자의 일측성 중심망막동맥 폐쇄를 경험하였고 이는 눈 증상이 선행된 비전형적인 결절다발동맥염의 증례로 이를 보고하고자 한다. 증례요약: 58세 남자 환자가 갑작스런 우안의 시력저하를 주소로 안과에 내원하였다. 현성굴절 검사를 통한 최대교정시력 우안 0.05, 좌안 1.0으로 확인되었으며, 고혈압, 당뇨 등의 전신기저 질환은 없는 상태로 10일 전 갑자기 발생한 우안의 시력저하와 간헐적으로 나타난 우측 편두통을 호소하였다. 대광반사에서 우안에 상대적 구심성 동공운동장애가 관찰되었으며 안저검사 및 빛간섭단층촬영 검사상 우안의 시신경유두 및 황반주변으로 안저의 전반적인 부종이 관찰되었다. 환자는 형광안저촬영 후 우안의 중심망막동맥 폐쇄로 진단 받았고 이후 임상소견과 검사실 결과, 영상검사를 근거로 결절다발동맥염 진단하에 면역억제치료를 시작하였다. 1개월 후 우안의 최대교정시력은 0.05로 확인되었다. 결론: 결절다발동맥염 환자에서 중심망막동맥폐쇄로 인한 시력저하가 첫 증상으로 나타날 수 있으며 안과에 내원하는 경우 관련 문진과 실험실 검사를 추가하여 빨리 진단 후 전신적인 치료를 시행하는 것이 추가적인 다른 합병증을 예방할 수 있을 것이다.
Abstract
Purpose: Polyarteritis nodosa (PAN) is the necrotic vasculitis affecting middle and small-sized arteries throughout the body including ocular tissue. We report an atypical PAN case of unilateral central retinal artery occlusion in which the ocular involvement occurred before systemic symptoms. Case summary: A 58-year-old male visited the ophthalmology department due to abruptly decreased visual acuity. Best corrected visual acuity (BCVA) was 0.05 (in the right eye) and 1.0 (in the left eye) basedon the Snellen chart. He complained of acute decreased vision occurring ten days prior and intermittent migraine on the right side with no underlying diseases, such as hypertension or diabetes mellitus. Relative afferent pupillary defect was observed in the right eye. Generalized edema was found around the optic disc and fovea on fundus examination and optical coherence tomography. The patient was diagnosed with central retinal artery occlusion (CRAO) based on a fluorescein angiography. Subsequently, PAN was diagnosed based on clinical features, laboratory test results and imaging studies. The treatment was started with an immunosuppressive agent. One month later, the BCVA was 0.05 based on the Snellen chart. Conclusions: In PAN patients, decreased vision can occur as a first symptom due to CRAO. If the patient visits the ophthalmology clinic, history taking and laboratory tests for PAN can aid in early diagnosis and treatment, as well as preventing additional complications of PAN.
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