検眼鏡的に急性後部多発性斑状網膜色素上皮症様所見を呈した原田病の1例

A case of Harada disease simulating acute posterior multifocal placoid pigment epitheliopathy

要約　56歳男性に5日前からの両眼充血，羞明，頭痛があり，2日前から両眼視力が低下して受診した。矯正視力は右0.7，左0.6で，両眼に虹彩炎の所見があった。5日後に視力が両眼とも0.03に低下し，下方眼底に胞状網膜剝離，後極部一帯に多発性の黄白色滲出斑を伴う漿液性網膜剝離が出現した。これら滲出斑は急性後部多発性斑状網膜色素上皮症（APMPPE）に酷似していた。フルオレセイン蛍光造影で黄白色斑は造影早期に低蛍光を呈さなかった。眼所見と全身所見から原田病と診断した。副腎皮質ステロイド薬の全身投与で網膜剝離は寛解し，視力が左右とも1.2に回復したが，夕焼け状眼底になった。

Abstract.　A 56-year-old male had bilateral hyperemia,photophobia and headache since 5 days before. Visual acuity started to deteriorate since 2 days before. His corrected visual acuity was 0.7 right and 0.6 left. Iritis was present in both eyes. Five days later,the visual acuity decreased to 0.03 in either eye. Both eyes showed bullous retinal detachment in the inferior periphery. Serous retinal detachment with numerous yellow-white placoid patches appeared in the posterior fundus. The finding was suggestive of acute posterior multifocal placoid pigment epitheliopathy（APMPPE）. The placoid patches did not show hypofluorescence in the early-phase fluorescein angiography. We diagnosed him with Harada disease based on ocular and systemic findings. Systemic corticosteroid was followed by prompt resolution of retinal detachment with improvement of visual acuity to 1.2 in either eye. Both eyes developed diffuse depimentation of the fundus simulating sunset-glow one year later.