原田病のステロイド大量療法漸減中に発症した中心性漿液性網脈絡膜症の1例

A case of central serous chorioretinopathy during tapering of systemic corticosteroid for Harada disease

要約　目的：原田病に対し副腎皮質ステロイドを大量投与し，その漸減中に中心性漿液性網脈絡膜症が発症した症例の報告。症例と所見：37歳男性が数日前からの両眼の眼痛，視力低下，耳鳴で受診した。矯正視力は右0.15，左0.6であり，両眼に漿液性網膜剝離があった。髄液に細胞数増加があり原田病の不全型と診断した。副腎皮質ステロイドの大量投与で網膜剝離は軽快し，12日後に左右とも1.2の視力に回復した。以後プレドニゾロンを少量投与していたが，発症から6か月後に右眼黄斑部に漿液性網膜剝離が生じ，蛍光眼底造影で中心性漿液性網脈絡膜症と診断した。プレドニゾロンの中止後4週間で網膜剝離は消失した。結論：原田病では副腎皮質ステロイドによる加療中に，中心性漿液性網脈絡膜症が発症することがある。

Abstract.　Purpose：To report a case of Harada disease who developed central serous chorioretinopathy（CSC）during tapering of systemic corticosteroid. Case and Findings：A 37-year-old male presented with bilateral ocular pain, blurring of vision, and tinnitus. His visual acuity was 0.15 right and 0.6 left. Both eyes showed serous retinal detachment. Pleocytosis was present in cerebrospinal fluid. He was diagnosed with incomplete form of Harada disease. Pulsed corticosteroid therapy was followed by resolution of retinal detachment 12 days later. He continued receiving peroral prednisolone at the daily dosis of 5mg. Serous retinal detachment developed in the right macula 6 months later. Fluorescein angiographic findings were compatible with CSC. Retinal detachment resolved 4 weeks after discontinuation of prednisolone. Conclusion：CSC may develop during corticosteroid therapy for Harada disease.