안와봉와직염의 호전 중 발생한 전두엽의 농양

목적: 안와봉와직염의 호전 중 발생한 전두엽의 농양을 경험하였기에 이를 보고하고자 한다. 증례요약: 54세 남자환자가 2일 전부터 발생한 좌안와 부위의 통증, 부종, 시력저하를 주소로 내원하였다. 좌안의 최대 교정시력은 0.3, 안압은 27 mmHg이었으며, 전방향의 안구운동장애가 있었고 4 mm 안구돌출 소견이 있었다. 안와전산화단층촬영상 전 부비동염과 좌안와봉와직염이 관찰되어 이비인후과에서 부비동 수술을 시행 후 항생제 치료를 하였으나 호전이 없었고 술 후 11일 째 촬영한 안와전산화단층촬영상 안와에 국한된 농양이 있어 절개 및 배농술을 시행하였다. 술 후 좌안 최대 교정시력 0.8, 부종 및 안구운동은 호전 되었으나 15일째 갑자기 발생한 두통을 호소하여 시행한 뇌 자기공명 영상촬영상 좌측 전두엽의 농양이 발견되어 신경외과에 의뢰해서 항생제 및 만니톨 정주 치료 하면서 경과 관찰 하였다. 두통은 점차 소실되었으며, 발병 3개월 째 촬영한 뇌자기공명영상촬영상 뇌농양도 거의 소실되었고, 발병 6개월째 안구운동 장애 소견 없으며 최대교정 시력은 1.0이었다. 결론: 안와봉와직염의 호전 중에도 신경학적 증상이 동반되는 경우, 뇌농양을 염두에 두어야겠다. Purpose: To present a case of brain abscess formation accompanied by improvement of orbital cellulitis. Case summary: A 54-year-old male came to our clinic complaining of swelling and pain of the left periorbital area and decreased visual acuity (VA) of the left eye. Initial best-corrected visual acuity (BCVA) was 0.3 and intraocular pressure was 27 mmHg in the left eye. Eye movement in all directions was restricted and 4 mm of proptosis was observed in the left eye. An orbital CT scan demonstrated pansinusitis and orbital cellulitis of the left eye. The patient underwent endoscopic sinus surgery and was treated with systemic antibiotics. However, periorbital swelling was aggravated and another orbital CT scan was performed and analyzed. The CT scan showed localized periorbital abscess of the left eye, and the authors performed an incision and drainage (I&D) of abscess procedure. After the operation, BCVA of the left eye was recovered to 0.8 and eye movement improved and periorbital swelling decreased. However, 15 days after the I&D, the patient complained of a severe headache. Brain magnetic resonance imaging (MRI) was performed and showed an abscess of the left frontal lobe of the brain. The authors consulted with a neurosurgeon, and the patient received intravenous antibiotics and mannitol. The headache steadily decreased, and three months after the first visit, a follow-up brain MRI was performed. The MRI showed almost complete disappearance of the abscess and six months after the first visit, BCVA was recovered to 1.0 and eye movement was full in all directions. Conclusions: Although orbital cellulitis is improved by treatment of antibiotics and surgery, if the patient complains of neurologic symptoms such as headache, other complications such as brain abscess formation should be considered. J Korean Ophthalmol Soc 2010;51(1):131-135