眼内炎と視神経炎を合併した眼トキソカラ症の1例

Endophthalmitis and optic neuritis in a case of ocular toxocariasis

　38歳男性が6週間前からの右眼の霧視で受診した。過去8年間，2週間に1回の割合で牛肝（レバー）を生で食べる習慣があった。矯正視力は右0.01，左1.2であった。右眼に毛様充血，前房混濁，硝子体混濁，眼底後極部一体に点状出血と滲出斑が多数あり，乳頭が発赤，浮腫状であった。磁気共鳴画像検査（MRI）で，右視神経が視交叉まで腫大していた。血清，髄液，硝子体の抗犬回虫抗体値が上昇していたために，眼トキソカラ症と診断した。副腎皮質ステロイド薬の全身投与で眼病変は寛解に向かい，初診から7か月後に0.7の視力に回復した。眼トキソカラ症が眼内炎と視神経炎の形で発症した1例である。

　A 38-year-old male presented with blurring of vision in his right eye since 6 weeks before. He had habitually eaten raw beef liver every two weeks in the past 8 years. His corrected visual acuity was 0.01 right and 1.2 left. His right eye showed ciliary injection,turbid aqueous,vitreous opacity,hemorrhage and exudates in the posterior fundus area,and optic disc edema. Magnetic resonance imaging（MRl）showed swelling of the right optic nerve extending to the chiasma. Elevated antibody titer to canine toxocara was found in the serum,vitreous,and the cerebrospinal fluid. He was diagnosed with ocular toxocariasis. Systemic corticosteroid induced gradual improvement of ocular manifestations. The right eye recovered visual acuity of 0.7 7months after his initial visit. This case illustrates that ocular toxocariasis may manifest as endophthalmitis and optic neuritis.