비인두암 환자 중 동시항암화학방사선요법 후 발생한 단순 헤르페스 뇌염

• Published in: The Korean journal of medicine Vol. 88; no. 5; pp. 602 - 607
• Main Authors: 최혜진, Hye Jin Choi, 이지은, Ji Eun Lee, 홍숙희, Suk Hee Hong, 전은경, Eun Kyung Jeon, 이시원, Sea Won Lee, 김연실, Yeon Shil Kim, 강진형, Jin Hyoung Kang
• Format: Journal Article
• Language: Korean
• Published: 대한내과학회 31.05.2015
• Subjects: Chemoradiotherapy; Herpes simplex encephalitis; Nasopharyngeal cancer; 내과학; 단순 헤르페스 뇌염; 동시항암화학 방사선요법; 비인두암
• ISSN: 1738-9364; 2289-0769
• DOI: 10.3904/kjm.2015.88.5.602

동시항암화학방사선요법 또는 전뇌방사선 치료 등을 시행하는 환자의 경우 면역 반응의 저하로 인하여 HSE가 발병할 확률이 증가하며 임상증상 및 검사 소견이 비특이적이다. 따라서 발열 및 의식 변화가 나타나는 환자에서는 HSE를 감별진단 중 하나로 고려해야 한다. 본 증례에서는 즉각적인 항바이러스 치료에 좋은 반응을 보였으며 비교적 양호한 임상경과를 보인, 동시항암화학방사선요법 시행 중에 병발한 HSE를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다. Herpes simplex encephalitis (HSE) is a rare viral encephalitis in adults. A high (70%) mortality rate with serious complications has been reported even after active, appropriate management. The association between HSE and immune suppression is unclear, but there are case reports of cancer patients in which HSE concomitantly developed after whole brain radiation or high-dose steroid treatment. The clinical manifestations and laboratory findings of these patients are atypical compared to the general population. Although brain magnetic resonance images reveal typical HSE findings, cerebrospinal fluid (CSF) analysis might be normal in cancer patients. We report a case of HSE in a 48-year-old male diagnosed with nasopharyngeal cancer and treated with concurrent chemoradiation. This patient had a normal cell count in CSF, but HSE was finally diagnosed from positive polymerase chain reaction test results. After administration of acyclovir and systemic steroid treatment, the patient had a good clinical course with few neurologic sequelae. (Korean J Med 2015;88:602-607)