황반부를 침범한 뎅기열 1예
A Case of Dengue Fever with Macular Involvement
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목적: 양안의 후극부를 침범한 뎅기열 감염 환자를 진단하고 치료한 경험을 보고하고자 한다. 증례요약: 31세 여자 환자가 인도네시아 발리 여행 중 발생한 발열을 주소로 입원 후 치료 도중 발생한 양안 시력 저하를 주소로 진료의뢰 되었다. 환자의 혈청 뎅기 바이러스 항체검사에서 뎅기 바이러스 IgM 항체 양성 결과를 보여 감염 내과에서 뎅기열로 진단하였다. 입원 2일째 우안 교정시력은 0.4, 좌안은 0.6으로 측정되었다. 세극등현미경검사상, 양안 유리체에서 약간의 염증세포를 관찰할 수있었고 안저검사에서 좌안 후극부에 망막 출혈과 양안 황반부종이 관찰되었다. 형광안저혈관조영술에서는 좌안 망막세정맥 주위 과형광을 인도사이아닌그린 형광안저혈관조영술에서는 전반적인 양안 초기 과형광을 보였다. 또한 자동시야검사에서는 양안의 전반적인시야감소와 중심주변부 암점의 증가를 보였다. 경과관찰 1주 뒤 망막부종과 안염증의 호전을 위해 좌안 테논낭하 트리암시놀론 주입술을 시행하였다. 테논낭하 주사 후 5주 뒤 양안의 교정시력은 1.0으로 호전되었으며 망막 부종과 망막 내 출혈 소견도 호전되었으나,자동시야 검사상 좌안 중심부주변 암점은 지속되었다. 결론: 뎅기열 감염 후에 양안 황반부종 및 망막염이 발생하였고, 우안은 보존적 치료로 호전되었고 좌안은 스테로이드 치료 후 호전된증례를 경험하였기에 이를 문헌고찰과 함께 보고하고자 한다.
Abstract
Purpose: To report a case of Dengue fever with bilateral macular edema and retinitis. Case summary: A 31-year-old female was referred to our clinic with blurred vision. The patient had visited Bali, Indonesiaapproximately 2 weeks prior. Dengue fever was diagnosed at the Division of Infectious Disease because the patient’s serumdengue virus antibodies test was positive for dengue viral IgM antibodies. The patient’s best corrected visual acuitywas 0.4 in the right eye and 0.6 in the left eye. Slit lamp examination showed inflammatory cells in the vitreous but not in theanterior segment of both eyes. Fundus examination showed thickening of the retina in both eyes as well as a splinter retinalhemorrhage in left eye. Fluorescein angiography revealed hyperfluorescence of the venule in the perifoveal vascularnetwork of the left macula, and indocyanine green angiography showed early diffuse hyperfluorescence in both eyes. Standard automated perimetry showed an overall reduction of the visual field and an increase in scotoma in both eyes. At1 week after the initial visit, the macular edema had not improved and the patient’s vision had deteriorated, especially in lefteye. To improve the macular edema and ocular inflammation, a subtenon triamcinolone acetonide injection in the left eyewas administered. At 5 weeks after treatment, corrected visual acuity improved to 1.0 in both eyes. Ocular findings, suchas macular edema and intraretinal hemorrhage were resolved. The patient did not complain of any remaining discomfort. However, standard automated perimetry revealed that a pericentral scotoma was still present in left eye. Conclusions: In the present study, the authors report a case of bilateral macular edema and retinitis at the posterior pole afterdengue infection. The patient demonstrated a relatively positive response to steroid therapy in the left eye and to conservativetreatment in the right eye.
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