증례 : 감염 ; HIV 감염 환자에서 발생한 Ramsay Hunt 증후군 1예 = Case Reports : Infectious disease ; Ramsay Hunt Syndrome in a Patient Infected with Human Immunodeficiency Virus

국문 초록 (Abstract)

RHS는 안면신경 무릎신경절에 수두대상포진바이러스(varicellar zoster virus)가 감염되어 있다가 얼굴과 귀에 분지되어 있는 감각 분지로 재활성화되어 발생한다. 전형적인 3가지 증상인 얼굴마비, 귀 통증, 외이도와 귓바퀴의 소수포성 발진이 나타나면 RHS라고 진단한다. 본 증례는 사람면역결핍바이러스 환자에서 RHS 진단과 치료의 국내 첫 보고이다. 40세 남자가 우측 귀 통증과 귀가 멍멍한 느낌을 주소로 내원하였다. 입원 직후 우측 얼굴의 말초 신경마비, 이루, 두통, 혀의 우측 운동 장애가 나타났으며 우측 외이도와 귓바퀴에 소수포성 발진이 관찰되었다. 입원 10일째 청력저하를 호소하였으며 고막 천공이 관찰되었다. 말초혈액 검사에서 사람면역결핍바이러스(HIV) 항체가 양성으로 도출되었고 확진 검사 양성이 확인되었다. CD4 T cell은 281/μL였다. 치료는 valacyclovir와 steroid를 투여하고 highly active antiretroviral therapy를 시행하였으며 안면마비를 포함한 증상은 치료 후호전되었으나 청력저하는 호전이 없었다.

다국어 초록 (Multilingual Abstract)

Ramsay Hunt syndrome is caused by reactivation of the varicella zoster virus in the geniculate ganglion of the sensory branch in the face and ears. It is characterized by peripheral facial palsy, ear pain, and vesicles in the auditory canal and auricle. We report on a first case of Ramsay Hunt syndrome in a patient with human immunodeficiency virus in Korea. The patient, a 40-year-old male, first presented with otalgia and ear fullness. On admission, he had right facial palsy of the peripheral type, otorrhea, headache, limited tongue movement, and right auricle vesicular eruptions. He had positive human immunodeficiency virus antibody and Western blot tests. His CD4 T cell count was 281/μL. The patient was treated with valacyclovir and steroid with highly active antiretroviral therapy. His symptoms and facial palsy improved with treatment. (Korean J Med 2016;90:169-172)

참고문헌 (Reference)

1 Vafai A, "Zoster in patients infected with HIV : a review" 321 : 372-380, 2001

2 Devaleenal DB, "Ramsay hunt syndrome in a person with HIV disease" 60 : 171-173, 2008

3 Goldani LZ, "Ramsay Hunt syndrome in patients infected with human immunodeficiency virus" 34 : 552-554, 2009

4 Wagner G, "Ramsay Hunt syndrome" 10 : 238-244, 2012

5 Grillo E, "Odynophagia, peripheral facial nerve paralysis, mucocutaneous lesions" 80 : 76-77, 2013

6 Bader MS, "Herpes zoster : diagnostic, therapeutic, and preventive approaches" 125 : 78-91, 2013

7 Opoku-Buabeng J, "Ear, nose and throat lesions in hiv/aids patients in komfo anokye teaching hospital, kumasi, ghana" 2 : 27-39, 2012

8 de Ru JA, "Combination therapy is preferable for patients with Ramsay Hunt syndrome" 32 : 852-855, 2011

9 Yawn BP, "A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction" 82 : 1341-1349, 2007

10 김창희, "A Case of Ramsay Hunt Syndrome with Cranial Polyneuropathy" 대한청각학회 16 (16): 80-82, 2012