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要約 目的:硝子体手術で採取した眼内組織の病理学的検索でサルコイドーシスの診断が確定した症例の報告。症例:51歳の女性が十数日前からの霧視と飛蚊症で受診。両眼に豚脂様角膜後面沈着物,虹彩と隅角に結節,眼底に蝋様の滲出斑があった。ツベルクリン反応が陰性である以外に全身検査で異常はなかった。初診から45か月後に黄斑上膜による視力障害が左眼に生じ,硝子体手術を行った。結果:採取した黄斑上膜に付着する硝子体混濁から,巨細胞を含む類上皮細胞肉芽腫が検出され,サルコイドーシスの診断が確定した。結論:全身検査所見がサルコイドーシスの診断基準を満たさない症例でも,眼内組織の病理学的検索で確定診断が得られる事例がある。
Abstract. Purpose:To report a case of sarcoidosis diagnosed by histopathological studies of intraocular tissue. Case:A 51-year-old woman presented with blurred vision and floating spots since 2 weeks before. Both eyes showed retrocorneal mutton-fat precipitates,nodules in the iris and chamber angle,and candle waxy exudates in the fundus. Repeated systemic and laboratory examinations were negative except for negative tuberculin test. Her left eye received vitreous surgery for epiretinal membrane 45months after her initial visit. Findings:Epitheloid granuloma including giant cells were histopathologically present in the vitreous tissue adherent to the epiretinal membrane,leading to the diagnosis of sarcoidosis. Conclusion:Histopathological studies of intraocular tissue may lead to definitive diagnosis of sarcoidosis even when systemic findings fail to satisfy accepted diagnostic criteria.
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