J Korean Ophthalmol Soc > Volume 61(10); 2020 > Article
Journal of the Korean Ophthalmological Society 2020;61(10):1246-1250.
DOI: https://doi.org/10.3341/jkos.2020.61.10.1246    Published online October 15, 2020.
Antineutrophil Cytoplasmic Antibody-associated Optic Neuritis
Junhyuck Lee, Jiwon Baek
Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
항호중구세포질항체 연관성 시신경염
이준혁, 백지원
가톨릭대학교 의과대학 부천성모병원 안과학교실
Correspondence:  Jiwon Baek, Tel: 82-32-340-2125, Fax: 82-32-340-2126, 
Email: md.jiwon@gmail.com
Received: 21 January 2020   • Revised: 2 March 2020   • Accepted: 22 September 2020
Abstract
Purpose
We report a case of antineutrophil cytoplasmic antibody (ANCA)-associated optic neuritis with glomerulonephritis.
Case summary
A 66-year-old male with a history of acute kidney injury presented with decreased visual acuity in both eyes. His best-corrected visual acuity (BCVA) was 0.15 in the right eye and 0.6 in the left eye. Both eyes showed optic disc swelling and Ishihara’s tests were 1/17. He was treated with intravenous methylprednisolone for 3 days to treat presumed bilateral optic neuritis. In follow-up, anti-myeloperoxidase antibody (anti-MPO antibody, p-ANCA) was positive at 32.0 IU/mL and ANCA-associated chronic sclerosing glomerulonephritis was found in the left kidney biopsy. He is currently being followed-up on oral steroids in the outpatient clinic. Kidney function improved immediately after high-dose steroid therapy. After 3 months of treatment, optic disc swelling resolved. On the other hand, there was minimal improvement in visual acuity.
Conclusions
In ANCA-associated optic neuritis with glomerulonephritis, both optic disc swelling and kidney function improved with steroid therapy. On the other hand, there was only a small improvement in visual acuity.
Key Words: Antineutrophil cytoplasmic antibody, Autoimmune optic neuropathy, Glomerulonephritis, Optic neuritis
국문초록
목적
사구체신염을 동반한 항호중구세포질항체와 연관된 시신경염의 증례를 보고하고자 한다.
증례요약
66세 남자 환자가 급성 신부전으로 본원 신장내과 외래 경과 관찰 중 양안 시력저하로 안과로 내원하였다. 교정시력은 우안 0.15, 좌안 0.6이었으며, 양안 유두부종(optic disc swelling)이 관찰되었고, 색각검사(Ishihara’s test)는 양안 1/17이었다. 양안 시신경염 소견하 고용량 스테로이드 Methylprednisolone 정맥 치료 후, 경구용 Prednisolone을 복용하며 외래 경과 관찰하였다. 혈청 anti-myeloperoxidase antibody 양성(32.0 IU/mL), 좌측 신장 조직검사상 항호중구세포질항체-연관성 만성 경화성 사구체신염 소견이 있었다. 환자는 고용량 스테로이드 치료 직후부터 신기능 향상 및 시신경유두부종 호전을 보였으며, 치료 3개월 뒤 양안의 시신경 유두부종은 완전히 호전되었으나, 교정시력은 우안 0.1, 좌안 0.7로 경한 호전만 보였다.
결론
사구체신염을 동반한 항호중구세포질항체와 연관된 시신경염에서 스테로이드 치료로 시신경부종 및 신기능은 호전되었으나 양안의 시력은 경한 호전만을 관찰할 수 있었다.


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