全身性エリテマトーデスの加療中に両眼性胞状網膜剝離を生じた1例

A case of bilateral bullous retinal detachment during treatment for systemic lupus erythematosus

要約　目的：重症全身性エリテマトーデス（SLE）に対する副腎皮質ステロイド薬を投与中に胞状網膜剝離が生じ，SLEが寛解するとともに網膜剝離が軽快した症例の報告。症例：59歳女性が関節痛と発熱を契機としてSLEと診断され，プレドニゾロンなどの全身投与を受けていた。第22病日に両眼の視力が低下した。矯正視力は右0.6，左0.5であり，滲出斑を伴わない胞状網膜剝離が両眼の後極部にあった。蛍光眼底造影と臨床所見とから，多発性後極部色素上皮症が疑われた。免疫吸着療法によりSLEの活動性が低下し，胞状網膜剝離と視力が改善した。結論：SLEによる脈絡膜血管炎にステロイド薬で網膜色素上皮症が誘発されたことで，胞状網膜剝離が発症した可能性がある。

Abstract.　Purpose：To report a case of bullous retinal detachment during treatment for systemic lupus erythematosus（SLE）. Case and Findings：A 59-year-old female had been diagnosed with SLE after acute fever and arthralgia. She had been treated by systemic prednisolone. She noted blurring of vision on day 22 of disease. Corrected visual acuity was 0.6 right and 0.5 left. Both eyes showed bullous retinal detachment in the posterior fundus. Clinical and fluorescein angiographic findings were suggestive of multifocal posterior pigment epitheliopathy. Improvement of SLE by immunoadsorption therapy was followed by improved visual acuity and resolution of bullous retinal detachment. Conclusion：There is a possibility that bullous retinal detachment was due to chorodial angiopathy secondary to SLE and to pigment epitheliopathy induced by systemic corticosteroid.