급성 전골수구백혈병에서 발생한 Retinoic Acid Syndrome 및 가성뇌종양

• 영문명: Retinoic Acid Syndrome and Pseudotumor Cerebri in Patients with Acute Promyelocytic Leukemia
• 발행기관: 대한안과학회
• 저자명: 김종호(Jong Ho Kim) 신용태(Yong Tae Shin) 박동호(Dong Ho Park) 김인택(In Taek Kim) 신재필(Jae Pil Shin)
• 간행물 정보: 『대한안과학회지』Ophthalmological Society,volume58,number6, 745~750쪽, 전체 6쪽
• 주제분류: 인문학 > 역사학
• 파일형태: PDF
• 발행일자: 2017.06.30

국문 초록

목적: 급성 전골수구백혈병 환자에서 all-trans retinoic acid (ATRA) 치료 중 발생한 retinoic acid syndrome에 의한 유리체출혈 및두개내압 상승에 의한 유두부종을 보고하고자 한다. 증례요약: (증례 1) 48세 여자로 ATRA 복용 중 두통, 호흡곤란 및 시력저하가 있었다. 양안 시력은 안전수동이었고 안저검사에서 망막및 망막전출혈과 유리체출혈이 있었다. 혈액검사에서 백혈구증가를 보였고, 뇌 및 흉부 컴퓨터단층촬영에서 지주막하출혈, 미만성 폐포출혈을 보였다. Retinoic acid syndrome에 의한 유리체출혈로 진단하고, 유리체절제술을 시행하였다. (증례 2) 17세 남자로 ATRA 치료 중 두통과 시력 장애가 있었다. 양안 시력은 1.0이었고 안저검사에서 양안에 유두부종과 망막출혈을 보였다. 시야검사에서 양안에 맹점이 커져 있었다. ATRA 유발 두개내압상승에 의한 유두부종으로 진단하고 경과 관찰하였다. 결론: 급성 전골수구백혈병 환자에서 ATRA 치료 중 합병증으로 retinoic acid syndrome 및 두개내압 상승이 발생 가능하며, 안과적으로 망막출혈, 유리체출혈 및 유두부종을 보일 수 있다.

영문 초록

Purpose: To report cases of a retinal, preretinal and vitreous hemorrhage due to retinoic acid syndrome and a papilledema caused by increased intracranial pressure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA). Case summary: (Case 1) A 48-year-old female visited our clinic with headache, dyspnea, and visual disturbance during ATRA medications for acute promyelocytic leukemia. Her visual acuity of both eyes was hand motion, and fundus examination revealed extensive retinal, preretinal, and vitreous hemorrhage. The laboratory test showed leukocytosis and computed tomography of brain and chest revealed subarachnoid hemorrhage and pulmonary alveolar hemorrhage. She was diagnosed with retinoic acid syndrome and was treated with vitrectomy in both eyes. (Case 2) A 17-year-old male, who had been treated with ATRA for acute promyelocytic leukemia, had headache and visual disturbance. His best-corrected visual acuity was 1.0 in both eyes, but the fundus examination showed papilledema and retinal hemorrhage in both eyes. Goldmann visual field examination revealed an enlarged blind spot in both eyes. He was diagnosed with papilledema caused by ATRA induced increased intracranial pressure, and was observed. Conclusions: Patients with acute promyelocytic leukemia treated with ATRA may have retinoic acid syndrome and increased intracranial pressure that could result in retinal hemorrhage, vitreous hemorrhage, and papilledema.

키워드

Acute promyelocytic leukemia All-trans retinoic acid Papilledema Pseudotumor cerebri Retinoic acid syndrome