高齢者に発症した原田病の2例と臨床的特徴

Clinical characteristics of Vogt-Koyanagi-Harada disease in two elderly persons

要約　背景：原田病の好発年齢は20～40歳代とされている。高齢で本症が発症すると，原田病に特有な皮膚などの眼外症状と加齢による変化との鑑別が困難である。ステロイドの大量投与で全身状態が悪化し，副作用が生じることがある。目的：2例の高齢者に発症した原田病の報告。症例：83歳女性と60歳男性を原田病と診断した。1例には数週間前から難聴と耳痛があり，4日前に眼痛と霧視を自覚した。矯正視力は右0.6，左0.4であった。左眼に虹彩炎，両眼に乳頭の発赤腫脹と乳頭黄斑間の網膜剝離があり，髄液に細胞増加があった。他の1例は両眼の霧視発症から2週間後に受診した。視力は右0.15，左0.2であり，両眼に角膜後面沈着物，乳頭の発赤浮腫，乳頭と黄斑間の網膜剝離があった。髄液に細胞増加があった。両症例ともHLA型がDR4陽性であった。両症例にステロイドパルス療法を行い，軽快した。症例1では打撲による頸椎骨折，症例2では炎症が再発した。結論：今回の2症例では，注意深いステロイドの全身投与が奏効し，髄液検査とHLAタイピングが診断に有効であった。

Abstract.　Background：Vogt-Koyanagi-Harada（VKH）disease is claimed to mainly affect persons in the third to fifth decade of life. When it occurs in persons in advanced age, difficulties may arise to distinguish the characteristic skin and extraocular manifestations of the disease from age-related physiological changes. Due attention is required with the use of systemic corticosteroid regarding systemic side effects in the elderly. Purpose：To report two cases of VKH disease in elderly persons. Cases：We diagnosed a 83-year-old female and a 60-year-old male with VKH disease. The first case had had ear pain and difficulty in hearing since 4 weeks. She noted ocular pain and blurring 4 days before. Her corrected visual acuity was 0.6 right and 0.4 left. Her left eye showed signs of iritis. Both eyes showed hyperemia and swelling of the optic disc with retinal detachment in the papillomacular area. Cerebrospinal fluid showed pleocytosis. The other case presented with 2 weeks after onset of blurring in both eyes. Visual acuity was 0.15 right and 0.2 left. Both eyes showed keratitic precipitates, disc edema and retinal detachment in the papillomacular area. Pleocytosis was present in the cerebrospinal fluid. Both cases were positive for DR4 by HLA typing. Pulsed corticosteroid was followed by improvement in both cases. Conclusion：VKH in the two aged persons responded well to systemic corticosteroid. HLA typing and cerebrospinal tap was useful in the diagnosis.