Tuberculosis and Respiratory Diseases

  • 제60권3호
  • /
  • Pages.353-356
  • /
  • 2006
  • /
  • 1738-3536(pISSN)
  • /
  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
권호 표지

다제내성 결핵에 의한 횡단척수염 1예

A case of Transverse Myelitis due to Multidrug-Resistant Tuberculosis

  • 이광하 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 나승원 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 박이내 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 최혜숙 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 정훈 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 전규락 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Lee, Kwang Ha (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ra, Seung Won (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, I-Nae (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Choi, Hye Sook (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jung, Hoon (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Chon, Gyu Rak (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae Sun (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2006.01.12
  • 심사 : 2006.03.13
  • 발행 : 2006.03.30
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초록

폐결핵 치료중 흉부엑스선상 악화 및 갑자기 발생한 하지 마비와 감각이상으로 자기공명영상 촬영후 급성 횡단척수염 진단 및 객담 검사상 다제내성 결핵균 검출로 2차 결핵약제와 스테로이드 병합치료를 시행하여 부분적으로 호전을 보였던 증례이다. 급성 횡단척수염은 매우 드문 질환이며 균주의 직접 침범이나 면역학적 기전으로 발생하나 후자가 더 가능성 있는 기전으로 생각되어지고 있다. 아직도 결핵 및 다제내성 결핵의 유병률이 높은 국내 상황에서 드물게 결핵이 원인으로 추정된 급성 횡단척수염의 증례를 보고하는 바이다.

Acute transverse myelitis (TM) is a neurological syndrome caused by inflammation of the spinal cord. TM is rare but is frequently caused by viral or bacterial infections. TM caused by tuberculosis (TB) is extremely rare and there are no reports of TM caused by multidrug-resistant TB (MDR-TB). We report a case of acute TM due to MDR-TB in a 40-year-old man. The patient had been diagnosed with pulmonary TB and was started on the first-line anti-TB treatment. However, the chest radiographic findings were aggravated and neurological symptoms such as weakness in both lower extremities, sensory changes, and voiding difficulty were newly developed. The T2-weighted magnetic resonance image of the spine showed diffusely increased signal intensity in the spinal cord, particularly at the lower cervical and upper thoracic levels, without any definite evidence of myeloradicular compression, which is consistent with a diagnosis of TM. A drug susceptibility test revealed MDR and second-line anti-TB drugs were prescribed. The chest radiographic findings showed improvement after treatment, the mycobacterial culture converted to negative, the MRI findings improved, and there was partial improvement in the low extremity weakness. The patient has been prescribing second-line anti-TB medications for 14 months.

키워드

참고문헌

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