홍역의 급성 감염 후 뇌증에서의 고용량 메틸프레드니솔론 투여 치험 2례

High-dose Methylprednisolone Pulse Therapy in Measles Postinfectious Encephalomyelitis: Two Cases of Successful Recovery

저자들은 홍역에 의한 급성 감염후 뇌척수염 환아에서 조기에 고용량 메틸프레드니솔론을 정주 투여하여 뇌 MRI상 광범위한 백질병변이 있었음에도 불구하고 후유증 없이 완쾌된 예를 경험하였기에 조금 늦게 같은 약제를 투여한 다른 증례와 비교하여, 이 질환에서의 고용량 메틸프레드니솔론 조기 치료를 강조하면서 문헌 고찰과 함께 보고하는 바이다

We treated two patients of measles postinfectious encephalomyelitis with intravenous methylprednisolone pulse therapy(1 g/1.73 m²/day for 5 days) 38 hours and 5 days respectively after the onset of neurologic symptoms. Despite extensive white matter involvement shown in MRI and severe clinical symptoms, the patients recovered from their neurologic symptoms dramatically following intravenous methylprednisolone pulse therapy. Because acute postinfectious encephalomyelitis has been postulated to be immunologically mediated disease, instead of direct viral invasion, ACTH and dexamethasone are widely used and the outcome is variable. This case report of successful recovery from fulminant ADEM with pulse intravenous methylprednisolone therapy, although uncontrolled, suggests that this therapeutic regimen should be studied in other cases.