妊娠が好影響を与えた再発性ぶどう膜炎の1例

A case of recurrent uveitis with remission during pregnancies

要約　　26歳女性が1週間前からの右眼視力低下で受診した。右眼には，虹彩炎，硝子体混濁，網膜出血と白色滲出斑，網膜静脈炎，乳頭浮腫があり，ベーチェット病を疑った。左眼は正常で，全身にも異常はなかった。プレドニゾロンとコルヒチンの経口投与を中心に加療したが，網膜滲出斑などの病変が再発を繰り返した。初診から28か月後に妊娠していることが判明したが，人工流産した。その後再び妊娠し，正常男児を出産した。2度の妊娠中，服薬は自発的に中止していた。ぶどう膜炎は妊娠中は軽快していたが，流産と出産後には病変が増悪した。妊娠が臨床経過に好影響を与えたと考えられる症例であり，妊娠による免疫抑制因子の増加や細胞性免疫の低下による母体免疫の変化がこれに寄与したと推定される。

Abstract.　A 26-year-old woman presented with blurring in her right eye since one week before. Her right eye showed iritis,vitreous opacity,retinal hemorrhage,exudates,retinal vasculitis and disc edema suggesting Behçet disease. Her left eye was normal. No systemic abnormalities were detected. She was given peroral prednisolone and colchicine,but her right eye developed recurrent exacerbations. She became pregnant 28 months after her initial visit which ended in abortion. She became pregnant again and gave birth to a healthy male baby. All medications were discontinued during the pregnancies. Her uveitis improved during pregnancies but exacerbated thereafter. This case illustrates that pregnancy may favorably affect the course of uveitis,possibly due to increased immunosuppressive factors and to suppression of cellular immunity.