顕微鏡的多発血管炎の眼合併症についての検討

Ocular complications of microscopic polyangiitis

59歳男性に間質性肺炎が発症した。5年前に腎腫瘍で部分切除を受けていた。その3か月前から肩と下腿に筋肉痛があった。核周囲抗好中球細胞質抗体（P-ANCA）が陽性でCRPの上昇があり，顕微鏡的多発血管炎と診断された。副腎皮質ステロイド療法と抗凝固療法でCRP値が改善した。発症から3か月後に右眼に違和感があり，乳頭浮腫が両眼にあり，網膜中心静脈閉塞症に発展した。視力は全期間を通じて正常であった。3か月後に自然寛解した。眼底病変は顕微鏡的多発血管炎の合併症であると解釈されたが，本症例では眼合併症が全身症状と時期的に相関していない。

A 59-year-old male developed interstitial pneumonia. He had received partial nephrectomy for renal tumor 5 years before. He had had muscular pain since 3 months before. He showed elevated C-reactive protein（CRP）and was positive for perinuclear anti-neutrophil cytoplasmic antibody（P-ANCA）and was diagnosed with microscopic polyangiitis. His systemic findings improved after systemic corticosteroid and anticoagulant therapy. Sickly feeling developed in his right eye 3 months later. Both eyes showed swelling of optic disc that later developed into central retinal vein occlusion. Visual acuity remained unimpaired throughout. Spontaneous recovery set in 3 months later. The ocular lesion was interpreted as complication of microscopic,polyangiitis,although ocular and systemic manifestations did not run a parallel course.