眼科受診を契機に診断に至った伝染性単核球症の1例

A case of infectious mononucleosis diagnosed after an ophthalmology visit

要約　目的：眼科受診を契機に確定診断に至った伝染性単核球症の1例について報告する。

症例：症例は10歳，女性。3週間前から持続する両側上眼瞼腫脹を主訴に初診。初診時，両側涙腺部に軽度の腫脹を認め，右眼に1mm×2mm，左眼に3mm×3mmの皮下腫瘤を触知した。MRIにて両側涙腺軽度腫大を認め，採血では異型リンパ球増加，AST，ALT上昇を伴っていた。小児科を受診し，頸部リンパ節腫脹，肝臓腫大を認め，抗EBウイルスIgM抗体陽性であったことから，伝染性単核球症の確定診断に至った。安静を指示し，2週間で症状は軽快した。

結論：伝染性単核球症が眼瞼腫脹を主訴に眼科を初診する場合があり，注意が必要である。

Abstract　Purpose：To report a case of infectious mononucleosis that was definitively diagnosed after an ophthalmology visit.

Case：A 10-year-old girl presented with bilateral upper eyelid swelling for 3 weeks. At the first visit, subcutaneous masses measuring 1×2 mm in the right upper eyelid and 3×3 mm in the left upper eyelid were palpable. Magnetic Resonance Imaging showed mild enlargement of the lacrimal glands on both sides, and blood sampling revealed an increase in atypical lymphocytes, aspartate aminotransferase and alanine aminotransferase levels. She visited a pediatric department and was found to have cervical lymphadenopathy and swelling of the liver and was positive for anti-EB virus IgM antibody, leading to a definitive diagnosis of infectious mononucleosis. The patient was instructed to rest, and her symptoms improved after 2 weeks.

Conclusion：Infectious mononucleosis may be the first visit to an ophthalmologist with the complaint of eyelid swelling.