류마티스 관절염 환자에서 발생한 식도 아스페르길루스증 1예 = A Case of Esophageal Aspergillosis Developed in Patient with Rheumatoid Arthritis

다국어 초록 (Multilingual Abstract)

Invasive fungal infections contribute substantially to death and illness. Invasive aspergillosis usually occurs in immunocompromised patients and is associated with high morbidity and mortality. Primary infection usually involves the respiratory tract following environmental exposure to Aspergillus and may, in severely immunocompromised patients, disseminate to other organs. A 35-year-old woman with history of rheumatoid arthritis for more than 10 years, developed dysphagia for 2 months following the combination therapy with prednisolone and etanercept. The patient was hospitalized and diagnosed as esophageal aspergillosis by gastroduodenoscopic biopsy. Fourteen days after initiation of itraconazole, dysphagia recovered completely. It is very rare case to develop only esophageal aspergillosis without invasion of any other organs. We report here, the case of localized aspergillosis in patient who took immunosuppressants for rheumatoid arthritis.

국문 초록 (Abstract)

아스페르길루스증은 주로 상기도 감염이나 부비동염을 일으키지만 드물게 식도염을 유발하기도 한다. 게다가 아스페르길루스증이 다른 장기로의 침범없이 식도염 단독으로 발현되는 경우는 매우 드물다. 아스페르길루스증의 호발인자로는 백혈병 같은 혈액종양 질환, 골수 혹은 장기이식, 면역억제제의 장기복용 등이 알려져 있다. 우리는 다른 장기로의 침범은 전혀 없이 식도염만 단독으로 발생한 환자의 증례를 경험하였다. 35세 여자 환자가 2-3개월 전부터 발생한 연하곤란으로 내원하였고 내시경하 조직검사를 통하여 식도 아스페르길루스증이 추정되었다. 본 환자는 당시 류마티스 관절염으로 etanercept와 스테로이드를 복용했었다. 환자는 itraconazole (400 mg/일, 경구, capsule) 2주 동안 복용하였고 증상은 호전되었다. 이처럼 면역력이 저하된 환자에 식도염이 발생하였을 경우 칸디다증 외에도 아스페르길루스증의 가능성도 고려해 보아야 한다.

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