눈결핵으로 오인된 Wegener 육아종증 1예

목적 : 눈결핵으로 오인된 맥락망막반혼을 동반한 Wegener 육아종증 1예를 경험하여 보고자 한다. 대상과 방법 : 내과에서 폐결핵 의심하에 치료 중인 65세 남자가 수개월간의 시력감소를 주소로 의뢰하였다. 초진시 우안 시력은 안전수지 30 cm이었고, 안저검사상 황반부를 침범한 맥락망막반혼이 있었다. 당시 눈결액의 맥락망막염에 의한 반혼으로 진단하고 내과적 치료를 계속하였으나, 초진 3개월경 반복되는 양안 앞포도막염의 소견을 보였다. 결과 : 초진 14개월 후 안장코를 주소로 이비인후과에 의뢰되어 혈약검사상 세포질성 항호중구 세포질항체(Cytoplasmic antineutrophil cytoplasmic antibody, c-ANCA) 양성 소견 및 비강 조직검사로 Wegner 육아종증이 확진되고 안과로 다시 의뢰되었다. 당시 양안 괴사성 공막염 및 안와 전산화 단층촬영상 내벽 및 하벽 골파괴 소견을 보였으나 안구돌출은 없었으며, Cyclophosphamide와 Predinisone을 전신적으로 투여하였다. 결론 : 눈결핵으로 오인된 맥락망막반혼을 동반한 Wegener 육아종증 1예를 경험하였으며 눈결액 의심시 반드시 감별해야 할 질환으로 사료된다. Purpose: To report a case of Wegener`s granulomatosis misdiagnosed as ocular tuberculosis. Methods: A 65-year-old man who was treated with anti-tuberculosis medications as suspected pulmonary tuberculosis was referred from the department of internal medicine f3r visual loss over months. His initia lvisual acuity was counting fingers at 30 cm in the right eye and there was a chorioretinal scar involving the macula on fundus examination. At that time, we thought that the lesion was a tuberculosis-related chorioretinal scar and so he was treated with anti-tuberculosis medications, There was a recurrent bilateral anterior uveitis during three months from the initial visit. Results: After 14 months, he was examined by otorhinolanmgologist due to a saddle nose deformity and Wegener`s granulomatosis was diagnosed based on positive Cytoplasmic antineutrophil cytoplasmic antibody(c-ANCA) and nasal mucosal biopsy. At that time, ocular examination revealed the necrotizing scleritis in both eyes and orbital CT showed bony destruction of medial and inferior orbital wall without proptosis in both eyes. We had treated with oral cyclophosphamide and prednisone. Conclusions: We experienced a case of Wegener`s granulomatosis with chorioretinal scar misdiagnosed as ocular tuberculosis. In conclusion, we should differentially diagnose Wegener`s granulomatosis from suspected ocular tuberculosis.