비감염결절성 및 진균성공막염으로 오인되었던 매독성공막염 1예

• 영문명: A Case of Syphilitic Scleritis Initially Misdiagnosed as Noninfectious Nodular or Fungal Scleritis
• 발행기관: 대한안과학회
• 저자명: 한상윤 이정진 권영아 송상률 김병엽 정재림,Sang Youn Han, MD, Jung Jin Lee, MD, Young A Kwon, MD, Sang Wroul Song, MD, Byoung Yeop Kim, MD, Jae Lim Chung, MD
• 간행물 정보: 『대한안과학회지』Ophthalmological Society,volume55,number8, 1233~1237쪽, 전체 5쪽
• 주제분류: 의약학 > 기타의약학
• 파일형태: PDF
• 발행일자: 2014.08.15

영문 초록

Purpose: To report a case of syphilitic scleritis initially misdiagnosed as noninfectious nodular or fungal scleritis. Case summary: A 63-year-old female, who had severe headaches and ocular pain in her left eye despite treatment with topical and oral NSAIDs for the past 4 months, was transferred from a local clinic. The patient had a history of pterygium excision in the same eye 4 years prior. Upon presentation, she had a scleromalacia with calcified plaque at the nasal conjunctiva. An erythematous nodular elevated lesion was observed in the superonasal sclera. Microbiological smear and cultures were performed to exclude infectious scleritis. Under the suspicion of noninfectious nodular scleritis, the patient was prescribed topical oral steroid and oral NSAIDs. Candida parapsilosis was identified by the microbiological culture. Under the suspicion of fungal scleritis, oral fluconazole and topical amphotericin B were administered, but the lesions did not improve. On the 23rd day of treatment, we discovered the patient had a history of syphilis. The serology test was negative for RPR and FTA-ABS IgM but positive for FTA-ABS IgG. Under the suspicion of syphilitic scleritis, oral doxycycline (200 mg bid) was administered and benzathine penicillin M (2.4 million units) was injected intramuscularly 3 times at 1-week intervals. After the doxycycline and benzathine penicillin therapy, the pain and nodular erythematous lesions were completely resolved. Conclusions: As shown in this case, syphilitic scleritis should be considered when the patient is resistant to other conventional treatments and shows positive serological tests for syphilis. This is important because syphilitic scleritis is usually aggravated by steroid treatment but can be cured by proper anti-syphilitic chemotherapy. J Korean Ophthalmol Soc 2014;55(8):1233-1237

키워드

Infectious scleritis, Scleritis, Syphilis, Syphilitic scleritis, Treponema pallidum