레이노 현상을 진단받은 환자에서 발생한 단안의 망막 반점 출혈 1예 = A Case of Monocular Retinal Blot Hemorrhage in a Patient with Raynaud’s Phenomenon

국문 초록 (Abstract)

목적: 우안 시력저하를 주소로 내원하여 우안에 국한된 망막 반점 출혈 소견으로 경과관찰 중 레이노 현상을 진단받은 1예를 경험하였기에 이를 보고하고자 한다.
증례요약: 65세 여자 환자가 하루 전부터 발생한 우안 시력장애를 주소로 내원하였다. 기왕력으로 고혈압을 2년 전에 진단받고 경구약 복용 중이었다. 최대 교정시력 우안 0.8 좌안 1.0이었고 안압은 우안 15 mmHg, 좌안 21 mmHg로 측정되었으며 안저 검사상 우안4 사분면에 걸친 망막 반점출혈과 망막 혈관 비틀림(tortuosity)이 증가된 소견이 관찰되었다. 시야검사 및 경 흉부 심장초음파, 목동맥 도플러 초음파 검사상 이상소견은 관찰되지 않았다. 혈액검사상 항핵항체 강 양성 및 항중심절항체 양성소견을 보여 류마티스내과와 협진하였고 전신성 피부 경화증, 전신성 홍반성 루푸스 등의 다른 류마티스 질환과의 연관성은 발견되지 않아 일차성 레이노현상으로 진단받게 되었다. 이후 혈액순환 개선제를 복용하며 경과관찰하였고 5개월 후 양안 교정시력은 각각 1.0이고 안저 촬영에서우안의 망막 반점출혈 소견은 소실되었다.
결론: 다른 안과적 원인이 배제된 비정형적 망막 반점출혈 소견을 보인 환자에게서 레이노 현상이 동반된 경우 레이노 현상 발현과연관된 망막 혈관의 자동 조절 기전의 변화가 망막 반점출혈의 기전과 관련이 있을 수도 있으므로 정밀검사 및 자세한 병력청취를 통해 레이노 현상 유무를 감별할 필요가 있다.

다국어 초록 (Multilingual Abstract)

Purpose: To report a case of retinal blot hemorrhage localized to 1 eye accompanied by Raynaud’s phenomenon.
Case summary: A 65-year-old female was referred for vision disorder in the right eye. She had been taking an antihypertensive drug since diagnosed with systemic hypertension 2 years previously. On initial examination, her best corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye and intraocular pressure was 15 mm Hg in the right eye and 21 mm Hg in the left eye. Fundus examination showed retinal blot hemorrhage across the entire retina and increased retinal vascular tortuosity. No specific finding was found on visual field examination, transthoracic ultrasonography and carotid Doppler ultrasound. The blood test was positive for antinuclear and anticentromere antibodies, thus she was referred to the rheumatologic department. The patient was diagnosed with primary Raynaud’s phenomenon because no correlation with other rheumatologic diseases was found.
Subsequently, she was scheduled for regular follow-ups with a prescription of circulatory stimulant. Five months later, her best corrected visual acuity was 20/20 in the both eyes and retinal blot hemorrhage in the right eye was significantly decreased based on fundus examination.
Conclusions: In the case of atypical retinal blot hemorrhage without other ophthalmic causes except Raynaud’s phenomenon,the change in retinal circulatory autoregulation associated with the mechanism of retinal blot hemorrhage can be presumed.Therefore, a close examination and history taking should be conducted so that Raynaud’s phenomenon as a pathological factor is not overlooked.

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