未熟児に発症した桐沢型ぶどう膜炎の1例

Acute retinal necrosis in a premature infant

要約　在胎週数29週，1,308gで生まれた女児の左眼に硝子体混濁が生後48日目に発見された。生後28日目の眼底検査では，両眼の耳側周辺部に血管新生を伴う無血管野のみがあった。生後51日目に，左眼眼底の鼻上側に小出血を伴う黄白色滲出巣が生じ，桐沢型ぶどう膜炎と診断した。アシクロビルと副腎皮質ステロイド薬の全身投与を行ったが，発症から約1か月後に右眼にも同様の病変が生じた。左眼は再発を繰り返したが，病巣は消炎，変性し，発症から3か月以降は再燃はなかった。生後3か月ころから口唇と手指に水疱が繰り返して起こり，単純ヘルペスウイルス感染がその原因であると推定した。

Abstract.　Vitreous opacity was detected in the left eye of a female infant on day 48 after birth. She had been born premature at 29 weeks of gestation with birthweight of 1,308g. When examined on day 28,both eyes had shown avascular area with neovascularization in the temporal periphery. On day 51,yellow exudates with hemorrhage appeared in the superior nasal area in her left fundus. She was given acyclovir and corticosteroid under the diagnosis of acute retinal necrosis. Similar fundus lesions developed in her right eye one month later while her left eye showed repeated recurrences. Eventually,the exudates became absorbed leaving chorioretinal scarring with no recurrence after 3 months of onset. After 3 months of age,repeated blistering occurred in her lips and fingers,suggesting herpes simplex virus as the cause of uveitis.