무증상의 만성 부신피질기능저하증 환자에서 Ebstein-Barr Virus 감염으로 인해 발생한 양측 부신의 출혈성 경색에 의한 급성 부신피질기능저하증 1예 = A Case of Acute Adrenal Insufficiency with Bilateral Adrenal Hemorrhagic Infarction due to Ebstein-Barr Virus Infection in a Patient with Asymptomatic Chronic Adrenal Insufficiency

국문 초록 (Abstract)

저자들은 기존에 발견되지 않았던 만성 부신피질기능저하증 환자에서 EBV 감염으로 인해 부신피질기능저하증이 더욱 심해지고 이차적으로 ACTH가 더 증가하게 되고, 증가된 ACTH에 의해 부신피질의 혈류 증가와 관조직 변성을 일으켜 출혈, 경색이 발생한 급성 부신피질기능저하증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

다국어 초록 (Multilingual Abstract)

Acute adrenal insufficiency may result from adrenal crisis, hemorrhagic destruction, or the rapid withdrawal of steroids from patient with chronic steroid medication, congenital adrenal hyperplasia or those on other drugs. Acute hemorrhagic destruction of both adrenal glands can occur due to infection, trauma, anticoagulant therapy, antiphospholipid syndrome or a coagulation disorder. However, there have been no reports on acute hemorrhagic adrenal insufficiency due to the Ebstein-Barr virus(EBV). Herein, a case of acute adrenal insufficiency, with bilateral adrenal hemorrhagic infarction, is reported in a patient with asymptomatic chronic adrenal insufficiency. A 42-year-old man presented with general weakness, weight loss and hyperpigmentation of several months duration. He suffered from a sore throat, general myalgia and a headache on admission. The laboratory findings were lymphocytosis, positive EBV IgM antibody, low cortisol level and a high level of adrenocorticotropic hormone(ACTH). Adrenocortical autoantibody and PCR for Mycobacterium tuberculosis showed negative findings. The serologic findings for CMV and HIV were negative. Fine needle aspiration of the adrenal gland revealed a hemorrhagic infarction and positive staining for the anti-EBV antibody. Acute adrenal insufficiency was then diagnosed with a bilateral adrenal hemorrhagic infarction due to the EBV infection in the patient, also with asymptomatic chronic adrenal insufficiency. This is the first case of acute adrenal insufficiency with bilateral hemorrhagic infarction, due to an EBV infection.

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