両眼の急性緑内障発作を呈した稀な原田病の1例

A case of Harada disease with bilateral acute glaucoma

目的：急性緑内障で初発した原田病症例の報告。症例：69歳女性が頭重感と嘔気で受診した。矯正視力は右眼1.0，左眼0.9で，両眼に約1.5Dの遠視があった。眼圧は両眼とも28mmHgであった。浅前房と狭隅角があり，両眼に急性緑内障発作と診断し，レーザー虹彩切開術で眼圧は下降した。両眼に視神経乳頭周囲の浮腫と全周に毛様体脈絡膜剝離があった。蛍光眼底造影で乳頭からの蛍光漏出があったが，典型的な点状の多発性蛍光漏出はなかった。造影磁気共鳴画像検査で脈絡膜に炎症所見があり，髄液細胞増多，HLA-DR4陽性などから原田病と診断した。結論：本症例は両眼の急性緑内障発作で初発し，漿液性網膜剝離を伴わない原田病であった。

Purpose：To report a case of Harada disease with acute glaucoma at the onset. Case：A 69-year-old female presented with headache and nausea. Her visual acuity was 1.0 right and 0.9 left when corrected for hyperopia by about 1.5 diopters. Intraocular pressure（IOP）was 28 mmHg in either eye. Both eyes showed shallow anterior chamber and narrow chamber angle. She was diagnosed with acute glaucoma in both eyes. Laser iridotomy resulted in normal IOP. Both eyes showed retinal edema around the optic disc and circumferential detachment of ciliary body and choroid. Fluorescein angiography showed dye leakage from the optic disc but no multiple fluorescein dots from the choroid. Magnetic resonance imaging showed bilateral thickening of the choroid. She showed pleocytosis in the cerebrospinal fluid and HLA pattern of positive DR-4. These findings led to the diagosis of Harada disease. Conclusion：This case illustrates that Harada disease may manifest acute glaucoma as the initial manifestation.