原田病に対する副腎皮質ステロイド薬全身投与時の合併症

Complications of systemic corticosteroid therapy for Vogt-Koyanagi-Harada disease

要約　目的：原田病に対するステロイド全身投与時の全身的合併症の報告。対象と方法：過去7年4か月間に加療した原田病のうち，発症から1か月以内の29例を検索した。男性15例，女性14例であり，年齢は13～71歳（平均46歳）で，すべて両眼発症であった。ステロイドは病状に応じ，3例には点眼，内服は9例，点滴は17例であり，うちパルス療法は12例に行った。結果：合併症として，内服群で糖尿病が1例に生じ，点滴群では糖尿病が3例，十二指腸潰瘍が1例，ウイルス血症が13歳の小児1例に生じた。さらに点滴群で胎児死亡が1例，原因不明の死亡が1例にあった。結論：原田病に対するステロイド薬の全身投与では，全身的合併症の可能性があり，十分な説明と慎重な投与が望ましい。

Abstract.　Purpose：To report major complications of systemic corticosteroid therapy for Vogt-Koyanagi-Harada disease. Cases and Method：This retrospective study was made on 29 cases who were treated during the past 7 years 4 months within one month after onset. The series comprised 15 males and 14 females. The age ranged from 13 to 71 years, average 46 years. All the cases were bilaterally affected. Depending on the severity, 3 cases were treated by topical instillation only, 9 cases by peroral medication, and 17 cases by intravenous infusion including 12 cases of pulsed corticosteroid therapy. Results：As major complications, one case developed diabetes mellitus after peroral medication. After intravenous infusion, diabetes mellitus developed in 3 cases, duodenal ulcer in one case, and viremia in a 13-year-old child. There was one fetal death after intravenous infusion. One case died of unknown cause. Conclusion：Treatment with systemic corticosteroid for Vogt-Koyanagi-Harada disease may induce major systemic complications. Patients ought to be duely informed and to be treated with caution.