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73歳男性の左眼に土が飛入し,前房混濁が発見された。抗菌薬や消炎薬で軽快せず,発症から5週後に紹介され受診した。左眼視力は0.4で,角膜後面沈着物と虹彩ルベオーシスがあった。眼底には異常所見がなかった。腫瘍性病変を疑い,前房水の生検を2回行ったが確定診断は得られなかった。当眼科受診の頃から左上半身に知覚と運動障害があり,腫瘍細胞の中枢神経への浸潤が疑われた。当眼科受診の5週後に診断的虹彩切除を行い,びまん性大細胞型B細胞性悪性リンパ腫の診断が確定した。右動眼神経麻痺が生じ,放射線照射と化学療法などを行ったが全身状態が悪化し,当眼科初診から10か月後に逝去した。悪性リンパ腫が,消炎治療に反応しない片眼性ぶどう膜炎の原因になり,著明な虹彩浸潤を起こすことを示す1例である。
A 73-year-old male was diagnosed with anterior uveitis after a piece of mud hit his left eye. Antiinflammatory or antifungal agents were futile. He was referred to us 5 weeks after the incident. His left eye had visual acuity of 0.4 and showed rubeosis iridis with keratic precipiatates. The fundus appeared normal. Biopsy of aqueous humor was performed twice but gave unequivocal findings. He then developed left hemiparesthesia and hemiparesis. Findings by radioisotopes were suggestive of infiltration of malignant tumors into the central nervous system. Biopsy of the iris was performed 5 weeks after his initial visit,leading to the diagnosis of diffuse macrocellular B-cell malignant lymphoma. This case illustrates that malignant lymphoma may show unilateral uveitis with marked iris infiltration as its initial manifestation.
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