COVID-19 mRNA 백신 주사 후 발생한 압박시신경병증을 동반한 전격 외안근염 1예

• Published in: Daihan angwa haghoi jabji pp. 465 - 469
• Main Authors: 최지연, 우경인
• Format: Journal Article
• Language: Korean
• Published: 대한안과학회 01.07.2024
• Subjects: 안과학
• ISSN: 0378-6471; 2092-9374
• DOI: 10.3341/jkos.2024.65.7.465

목적: COVID-19 messenger ribonucleic acid (mRNA) 백신 주사 이후 발생한 양안 외안근염과 이로 인한 압박시신경병증 1예를 보고하고자 한다. 증례요약: 51세 남자 환자가 BNT162b2 (Pfizer®, New York, NY, USA) 2차 주사 수시간 뒤 발생한 양안 시력저하와 전방향 안구운동제한을 주소로 내원하였다. 최대교정시력 우안 안전수지 30 cm, 좌안 안전수지 50 cm였고 양안 안검부종, 발적, 색각 저하를 보였다. 안와 자기공명영상에서 양안 외안근 비대 및 조영증강 소견을 보여 백신 연관 양안 외안근염과 압박시신경병증 진단 하에 고용량 부신피질호르몬 치료를 시행하였다. 1달 뒤 시력, 색각 호전을 보였고, 안검, 결막, 외안근의 염증성 징후도 소실되었다. 그러나 COVID-19 감염 직후 상기 증상 재발을 보였고, 부신피질호르몬으로 치료하였으나 우안 색각 저하와 양안 안검, 외안근의 염증성 징후가 남아 있어 안와 방사선 치료를 시행하였다. 이후 상기 증상 모두 호전되어 재발 없이 안정적으로 경과 관찰 중이다. 결론: 급성 전격 외안근염과 이로 인한 압박시신경증이 COVID-19 mRNA 백신 및 감염과 연관되어 발생할 수 있고 항염증 치료로 잘 치료되었다. Purpose: We present a case of bilateral compressive optic neuropathy secondary to orbital myositis after COVID-19 messenger ribonucleic acid (mRNA) vaccination. Case summary: A 51-year-old man developed acute bilateral visual loss and painful ophthalmoplegia shortly after receiving the second dose of the BNT162b2 COVID-19 mRNA vaccine (Comirnaty, Pfizer®, New York, NY, USA). His best-corrected visual acuity was counting fingers at 30 cm and 50 cm in the right and left eyes, respectively. Bilateral eyelid swelling, erythema, conjunctival injection, and color vision deficit were observed. Orbital magnetic resonance imaging revealed diffuse enhancement and hypertrophy of the bilateral extraocular muscles. The patient had no significant ophthalmic history and systemic work-up revealed no evidence of underlying inflammatory disease. Based on the clinical presentation and imaging findings, he was tentatively diagnosed with bilateral compressive optic neuropathy secondary to orbital myositis after COVID-19 mRNA vaccination. He was treated with intravenous corticosteroids for 3 days followed by low-dose oral corticosteroids. One month later, his visual acuity and color vision improved; moreover, the inflammatory signs in the eyelids, conjunctiva, and extraocular muscles resolved. However, after developing COVID-19, he experienced a recurrence of symptoms and was retreated with corticosteroids. Radiotherapy was administered to address persistent color vision deficit in the right eye and recurrent eyelid edema, erythema, and conjunctival injection. This treatment effectively resolved all inflammatory signs and color vision deficits, without signs of recurrence. Conclusions: Acute fulminant orbital myositis with associated compressive optic neuropathy can manifest after COVID-19 mRNA vaccination and onset of COVID-19. Anti-inflammatory treatment measures can effectively control these manifestations. KCI Citation Count: 0