The Korean Journal of Medicine

  • 제82권5호
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  • Pages.642-646
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  • 2012
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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결핵에 의한 시신경교차 거미막염 1예

A Case of Tuberculous Optochiasmatic Arachnoiditis

  • 박소은 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김지범 (울산대학교 의과대학 서울아산병원 내과) ;
  • 강보형 (울산대학교 의과대학 서울아산병원 내과) ;
  • 안지현 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김유재 (울산대학교 의과대학 서울아산병원 내과) ;
  • 임현택 (울산대학교 의과대학 서울아산병원 안과) ;
  • 김성한 (울산대학교 의과대학 서울아산병원 내과)
  • Park, So-Eun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Ji-Beom (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Bo-Hyoung (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • An, Ji-Hyun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, You-Jae (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Hyun-Taek (Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sung-Han (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2012.05.01
⟨ 이전 논문 다음 논문 ⟩

초록

결핵성 시신경교차 거미막염은 결핵성 수막염의 드문 합병증으로 심각한 시각 장애를 유발할 수 있으나, 항결핵제를 사용하고 있는 도중에도 발생할 수 있고, 항결핵제에 의한 안독성 증상과 혼돈될 수 있다. 저자들은 에탐부톨 독성에 의한 시각 장애로 오인되었던 결핵성 시신경교차 거미막염을 경험하였으므로 결핵성 수막염으로 항결핵제 치료를 받고 있는 환자에서 시각 장애 증상을 보일 경우, 결핵성 시신경교차 거미막염의 가능성을 고려하여 뇌 자기공명영상 및 안과적 검사를 적극적으로 시행을 고려해야 할 것으로 생각한다.

Tuberculous optochiasmatic arachnoiditis (OCA) is a rare complication of tuberculous meningitis. We describe a 47-year-old female with tuberculous OCA confused with ethambutol-associated optic neuropathy. She was on anti-tuberculous treatment (i.e., isoniazid, rifampin, ethambutol, and pyrazinamide) for two months due to tuberculous meningitis. Visual impairment occurred during treatment, and ethambutol was changed to levofloxacin because of concern for ethambutol-associated optic neuropathy. Her visual impairment did not improve three months after anti-tuberculous treatment that excluded ethambutol, and she was referred to our hospital. Brain MRI showed enhancement of the optic chiasm and bilateral optic tract, and fundoscopy revealed bilateral optic nerve atrophy, suggesting tuberculous OCA. Her visual acuity was partially improved after anti-tuberculous treatment. Tuberculous OCA should be considered in addition to ethambutol-associated optic neuropathy for a patient with tuberculous meningitis who presents with visual impairment.

키워드

참고문헌

  1. Jung DS, Oh YJ, Kwon KT, et al. Diagnostic validity of weighted diagnostic index scores for tuberculous meningitis in adults. Korean J Med 2008;75:316-321.
  2. Iraci G, Galligioni F, Gerosa M, et al. Opto-chiasmatic arachnoiditis: a review of traditional neuroradiological diagnosis (82 cases, 1951-1976). Acta Neurochir (Wien) 1979;48:151-176. https://doi.org/10.1007/BF02056965
  3. Gourie-Devi M. Optochiasmatic arachnoiditis and neurotuberculosis: prognostic indicators and therapeutic strategies. Neurol India 2010;58:714-715. https://doi.org/10.4103/0028-3886.72174
  4. Silverman IE, Liu GT, Bilaniuk LT, Volpe NJ, Galetta SL. Tuberculous meningitis with blindness and perichiasmal involvement on MRI. Pediatr Neurol 1995;12:65-67. https://doi.org/10.1016/0887-8994(94)00107-D
  5. Schoeman JF, Andronikou S, Stefan DC, Freeman N, van Toorn R. Tuberculous meningitis-related optic neuritis: recovery of vision with thalidomide in 4 consecutive cases. J Child Neurol 2010;25:822-828. https://doi.org/10.1177/0883073809350507
  6. Fraunfelder FW, Sadun AA, Wood T. Update on ethambutol optic neuropathy. Expert Opin Drug Saf 2006;5:615-618. https://doi.org/10.1517/14740338.5.5.615
  7. Kulkarni HS, Keskar VS, Bavdekar SB, Gabhale Y. Bilateral optic neuritis due to isoniazid (INH). Indian Pediatr 2010;47:533-535. https://doi.org/10.1007/s13312-010-0083-5
  8. Cho OH, Park KH, Kim T, et al. Paradoxical responses in non-HIV-infected patients with peripheral lymph node tuberculosis. J Infect 2009;59:56-61. https://doi.org/10.1016/j.jinf.2009.05.006
  9. Cho OH, Park KH, Park SY, et al. Drug-resistant extrapulmonary tuberculosis. Infect Chemother 2011;43:258-261.
  10. Blackmore TK, Manning L, Taylor WJ, Wallis RS. Therapeutic use of infliximab in tuberculosis to control severe paradoxical reaction of the brain and lymph nodes. Clin Infect Dis 2008;47:e83-e85. https://doi.org/10.1086/592695