항호중구세포질항체 연관성 시신경염 = Antineutrophil Cytoplasmic Antibody-associated Optic Neuritis

다국어 초록 (Multilingual Abstract)

Purpose: We report a case of antineutrophil cytoplasmic antibody (ANCA)-associated optic neuritis with glomerulonephritis.
Case summary: A 66-year-old male with a history of acute kidney injury presented with decreased visual acuity in both eyes. His best-corrected visual acuity (BCVA) was 0.15 in the right eye and 0.6 in the left eye. Both eyes showed optic disc swelling and Ishihara’s tests were 1/17. He was treated with intravenous methylprednisolone for 3 days to treat presumed bilateral optic neuritis. In follow-up, anti-myeloperoxidase antibody (anti-MPO antibody, p-ANCA) was positive at 32.0 IU/mL and ANCA-associated chronic sclerosing glomerulonephritis was found in the left kidney biopsy. He is currently being followed-up on oral steroids in the outpatient clinic. Kidney function improved immediately after high-dose steroid therapy. After 3 months of treatment, optic disc swelling resolved. On the other hand, there was minimal improvement in visual acuity.
Conclusions: In ANCA-associated optic neuritis with glomerulonephritis, both optic disc swelling and kidney function improved with steroid therapy. On the other hand, there was only a small improvement in visual acuity.

국문 초록 (Abstract)

목적: 사구체신염을 동반한 항호중구세포질항체와 연관된 시신경염의 증례를 보고하고자 한다.
증례요약: 66세 남자 환자가 급성 신부전으로 본원 신장내과 외래 경과 관찰 중 양안 시력저하로 안과로 내원하였다. 교정시력은 우안 0.15, 좌안 0.6이었으며, 양안 유두부종(optic disc swelling)이 관찰되었고, 색각검사(Ishihara’s test)는 양안 1/17이었다. 양안 시신경염 소견하 고용량 스테로이드 Methylprednisolone 정맥 치료 후, 경구용 Prednisolone을 복용하며 외래 경과 관찰하였다. 혈청 anti-myeloperoxidase antibody 양성(32.0 IU/mL), 좌측 신장 조직검사상 항호중구세포질항체-연관성 만성 경화성 사구체신염 소견이 있었다. 환자는 고용량 스테로이드 치료 직후부터 신기능 향상 및 시신경유두부종 호전을 보였으며, 치료 3개월 뒤 양안의 시신경유두부종은 완전히 호전되었으나, 교정시력은 우안 0.1, 좌안 0.7로 경한 호전만 보였다.
결론: 사구체신염을 동반한 항호중구세포질항체와 연관된 시신경염에서 스테로이드 치료로 시신경부종 및 신기능은 호전되었으나 양안의 시력은 경한 호전만을 관찰할 수 있었다.

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