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증례 : 류마티스 ; 강직성 척추염 환자에서 동반된 급성 횡단성 척추염
황덕원 ( Deok Won Hwang ),김재훈 ( Jae Hoon Kim ),김진주 ( Jin Ju Kim ),김은경 ( Eun Kyoung Kim ),김은미 ( Eun Mi Kim ),김현영 ( Hyun Young Kim ),김태환 ( Tae Hwan Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
급성 횡단성 척추염은 강직성 척추염에서의 염증성 요통과 다른 양상의 기계적 요통을 유발하며, 드물게 발생하지만 빠른 진단과 치료가 예후를 결정한다. 강직성 척추염과 급성횡단성 척추염과의 연관 관계는 아직 확실하지 않으나, 강직성 척추염에서 동반되는 신경학 증상과 유사한 병인을 가지며, 강직성 척추염에 병발된 급성 횡단성 척추염의 예가 보고된 바 있다[4,6]. 따라서 강직성 척추염 환자가 호소하는 요통에 대해 접근할 때 요통의 양상에 대한 정확한 문진이 필요하며 동반된 신경학적 증상의 유무도 살펴보는 것이 중요하다. Neurological manifestations as extra-articular features of ankylosing spondylitis (AS) have not been reported often, and present as root lesions, cauda equina syndrome, and compression of the spinal cord. We report a 31-year-old man who complained of back pain and claudication of both lower extremities. The patient showed typical inflammatory back pain and significant sacroiliitis, consistent with AS. He also had mechanical back pain and unexplained neurological symptoms. A neurological evaluation, including spinal magnetic resonance imaging and a cerebrospinal fluid study, revealed that the patient had acute transverse myelitis (ATM). ATM can be associated with connective tissue diseases. The pathophysiology of ATM consists primarily of inflammatory disorders, similar to the neurological complications of AS. We suggest that ATM is a possible extra-articular manifestation of AS. (Korean J Med 2011;80:S314-S318)
김태환 ( Tae Hwan Kim ),김은경 ( Eun Kyoung Kim ),이강원 ( Kang Won Lee ),정경희 ( Kyong Hee Jung ),백승삼 ( Seung Sam Paik ),박수역 ( Soo Yuck Park ),황덕원 ( Deok Won Hwang ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.1
Etanercept is a soluble receptor fusion protein that inhibits tumor necrosis factor-alpha(TNF-α). The receptor is used widely in the treatment of ankylosing spondylitis, rheumatoid arthritis, sarcoidosis and other indications. For sarcoidosis, it potentially suppresses granuloma formation with TNF-α blocking. On the other hand, recent studies have suggested that paradoxical sarcoidosis can be induced by TNF-α antagonists in some cases. A 42-yearold woman, who was treated with etanercept due to ankylosing spondylitis for 5 years, was admitted because of right suprahilar lymphadenopathy on chest radiography. Chest computed tomography revealed an enlargement of supraclavicular, paratracheal, mediastinal lymph nodes. She was diagnosed with sarcoidosis on the supraclavicular lymph node biopsy, which was non-caseating epithelioid cell granuloma and excluded from similar diseases. She was treated for sarcoidosis with prednisolone instead of etanercept.