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53歳女性が5日前からの左眼視力低下で受診した。8か月前に抗好中球細胞質抗体(anti-neutrophil cytoplasmic antibody:ANCA)関連腎炎と診断された。プレドニゾロンの大量療法のあと,1日量5mgを内服中であった。矯正視力は右1.0,左0.3であり,左眼に中心暗点があった。球後視神経炎と診断し,初診の10日後からプレドニゾロン内服を1日量40mgから開始した。3日後に左眼視力は1.2になり,その1か月後に中心暗点は消失した。本症例はANCA関連腎炎に続発した球後視神経炎の最初の報告例である。視神経炎がANCA関連腎炎の部分病変である可能性がある。
A 53-year-old woman presented with impaired left visual acuity since 5 days before. She had been diagnosed with nephritis related to anti-neutrophil cytoplasmic antibody(ANCA). She had been treated by massive systemic prednisolone initially and later by daily dosis of 5mg of the same. Her best corrected visual acuity was 1.0 right and 0.3 left. Central scotoma was present in the left eye,leadiang to the diagnosis of retrobulbar optic neuritis. Ten days after her initial visit,she started receiving daily dosis of prednisolone 40mg. Her left visual acuity improved to 3 days later. Central scotoma disappeared one month later. To our best knowledge,this is the first reported case of optic neuritis associated with ANCA-related nephritis. There is a possibility that optic neuritis may be a part of clinical manifestations of ANCA-related nephritis.
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