急性散在性脳脊髄炎を伴ったぶどう膜炎の1例

A case of uveitis followed by acute disseminated encephalomyelitis

　69歳女性が両眼飛蚊症で紹介受診した。矯正視力は右1.0，左1.2であり，左眼に前房細胞，硝子体混濁，網膜滲出斑と出血があった。硝子体手術で悪性リンパ腫は否定された。10週後に歩行障害が出現し，画像検査，髄液所見，脳生検などで急性散在性脊髄炎の診断が確定した。副腎皮質ステロイド薬の全身投与で軽快し，以後神経症状の再発はない。その10か月後に左硝子体混濁が悪化し，硝子体手術で悪性リンパ腫は再び否定された。急性散在性脊髄炎がぶどう膜炎の原因の1つである可能性がある。

　A 69-year-old female was referred to us for seeing flies. Her corrected visual acuity was 20/20 in either eye. Her left eye showed cells in the anterior chamber,vitreous opacity,exudates and hemorrhages in the peripheral retina. Malignant lymphoma was ruled out by vitrectomy. She developed gait disturbance 10 weeks later. Diagnostic imaging,brain biopsy and cerebrospinal fluid findings led to the diagnosis of acute disseminated encephalomyelitis. Systemic corticosteroid induced normalization of neurological findings. Vitreous opacity recurred 10 months later. Malignant lymphoma was again ruled out by vitrectomy. This case illustrates that uveitis may anticipate acute disseminated encephalomyelitis.