ステロイドパルス療法が奏効した両眼同時発症の特発外眼筋炎の1例

Corticosteroid pulse therapy was effective in a case of bilateral orbital myositis

42歳女性が2週間前からの両眼の眼瞼腫脹，結膜浮腫，眼痛，複視で受診した。第一眼位は正位であったが，両眼とも全方向に眼球運動制限があった。CTで両眼の4直筋に顕著な肥大と眼球突出があり，外眼筋炎と診断した。メチルプレドニゾロンのパルス療法で翌日から眼球突出と結膜浮腫が軽減し，続いて4直筋の肥大が減少し，1か月後に眼球運動制限が消失した。以後10か月間の現在まで外眼筋炎の再燃はない。外眼筋炎に対する早期のステロイドパルス療法が著効を示した1例である。

A 42-year-old female presented with bilateral lid swelling,conjunctival edema,pain and diplopia of 2 weeks' duration. Primary eye position was normal. Eye movement was restricted in all directions in both eyes. Computed tomography（CT）showed exophthalmos and marked swelling of 4 recti muscles in both eyes,leading to the diagnosis of external orbital myositis. She was treated by pulsed therapy of methylprednisolone. Exophthalmos and conjunctival edema started to regress on day 2 of treatment,followed by decreased hypertrophy of recti muscles. The ocular movement became normalized one month later. There has been no recurrence of orbital myositis during 10 months until present. This case illustrates that pulsed corticosteroid therapy may be effective for orbital myositis if started early.