한냉글로불린혈증 환자에서 발생한 급성호흡곤란증후군 1예

A Case of Cryoglobulinemia-induced Acute Respiratory Distress Syndrome

  • 김병규 (고려대학교 의과대학 내과학교실) ;
  • 심재정 (고려대학교 의과대학 내과학교실) ;
  • 정기환 (고려대학교 의과대학 내과학교실) ;
  • 신정호 (고려대학교 의과대학 내과학교실) ;
  • 이승헌 (고려대학교 의과대학 내과학교실) ;
  • 공희상 (고려대학교 의과대학 내과학교실) ;
  • 김제형 (고려대학교 의과대학 내과학교실) ;
  • 박상면 (원광대학교 의과대학 내과학교실) ;
  • 신철 (고려대학교 의과대학 내과학교실) ;
  • 인광호 (고려대학교 의과대학 내과학교실) ;
  • 강경호 (고려대학교 의과대학 내과학교실) ;
  • 유세화 (고려대학교 의과대학 내과학교실)
  • Kim, Byung-Gyu (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Shim, Jae-Jeong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Jung, Ki-Hwan (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Shin, Jeong-Ho (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Lee, Seung-Heon (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Kong, Hee-Sang (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Kim, Je-Hyeong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Bak, Sang-Myeon (Department of Internal Medicine, College of Medicine, Wonkwang University) ;
  • Shin, Chol (Department of Internal Medicine, College of Medicine, Korea University) ;
  • In, Kwang-Ho (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Kang, Kyung-Ho (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Yoo, Se-Hwa (Department of Internal Medicine, College of Medicine, Korea University)
  • 발행 : 2001.08.30

초록

한냉글로불린혈증에 의한 급성호흡곤란증후군은 극히 드문 것으로 보고되었다. 저자 등은 B형 간염을 가진 환자에서, 한냉글로불린혈증과 그에 인한 급성호흡곤란 증후군이 발생한 1예를 경험하였기에 보고하는 바이다.

Cryoglobulinemia is the presence of globulins in the serum that precipitate on exposure to cold temperatures(cryoglobulins). Pulmonary complications of cryoglobulinemia include interstial infiltration, impaired gas exchange, small airway disease and pleurisy. Only one other acute respiratory distress syndrome(ARDS) case has been described in patients with cryoglobulinemia. A 55-years old man was admitted with dyspnea. He had been diagnosed as being a hepatitis B virus antigen carrier 15 years ago. On the first admission, chest radiography showed a bilateral pleural effusion and a patchy infiltration on both lungs. On protein- and immuno-electrophoresis, cryoglobulinemia was confirmed. The patient was treated with corticosteroid and plasmapheresis. Forty-five days after the diagnosis, the patient complained of progressive dyspnea and showed a diffuse bilateral pulmonary infiltration on chest radiography. Despite intensive care with mechanical ventilation, the patient died as consequence of hypoxemia and multiple systemic organ failure. On a pathologic examination of the postmortem lung biopsy, multiple necrotizing vasculitis and increased infiltration of the lymphocytes and monocytes were observed. In conclusion, ARDS developed as a result of pulmonary hemorrhage due to cryoglobulinemia-associated vasculitis.

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