파종성 임균 감염과 급성 C형 바이러스 간염이 동반된 1례 = A Case of Concomitant Disseminated Gonococcal Infection with Acute Viral Hepatitis C

다국어 초록 (Multilingual Abstract)

Gonorrhea is endemic in developing countries. Frequent sexual contacts are common among travellers to endemic countries and the risk of sexually transmitted disease as gonorrhea is believed to be high. Disseminated gonococcal infection (DGI) results from blood dissemination of Neisseria gonorrhoeae from the primary mucosal infection and is a common cause of infective arthritis in sexually active adults in the USA. The usual manifestations of DGI are dermatitis, tenosynovitis, and septic arthritis. We experienced a case of DGI concomitant with acute viral hepatitis C, probably acquired by sexual contacts in Philippines. A 40-year-old man took a trip to Philippines and stayed for a week. During his stay in Philippines, a hemorrhagic bulla and several pustules developed on his extrimities. Subsequently he suffered from high fever and arthralgia of several joints, including both knee joints. Neisseria gonorrhoeae was identified by culture of an aspirate from the right knee joint and he was managed with ceftriaxone for 3 weeks under the diagnosis of DGI and gonococcal arthritis. During the follow-up at the outpatient clinic, alanine aminotransferase and aspartate aminotransferase levels began to rise and an anti-HCV antibody became positive. Because HCV viral loads were surging up from 56,703 copies/mL to 538,292 copies/mL during the next 4 weeks, interferon-alpha 2b was administered for 6 months with resultant normal liver function tests and undetectable HCV viral loads.

국문 초록 (Abstract)

임질은 개발도상국에 흔한 질환이며 이 지역으로 여행하는 해외 여행자에서도 성인성질환의 중요 원인이다. 또한 다른 성인성 질환과 동반되어 발생하기도 한다. 임균은 대부분은 점막에 국한하는 감염을 일으키지만 일부 환자에서는 점막외 부위에 감염을 일으키며 파종성임균감염이 가장 흔한 전신 감염형태이다. 파종성 임균감염은 열과 오한, 피부 병변, 건활막염, 이동형 관절염으로 나타나며, 국내에서는 이에 대해 보고가 없었다. 또한 C형 바이러스 간염이 성접촉 후 발생한다는 것을 직접 증명한 예가 없었다.필리핀 여행 후 40세 남자 환자가 발열, 다관절통, 출혈성 수포, 농포로 내원하여 활액 검사에서 임균이 관찰되어, 전신성 임균 감염으로 진단되어 ceftriaxone으로 치료하였다. 또한 외래에서 경과 관찰 중 간기능 이상과 anti-HCV 양성전환을 보여 급성 C형 바이러스 간염을 진단하고 interferon-α2b로 치료 후 증상의 호전을 보인 예를 경험했기에 문헌고찰과 함께 보고하는 바이다.

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