健常な若年男性に生じた原因不明の黄斑部網膜下滲出性病変

Idiopathic submacular exudation in a healthy young male

要約　目的：原因不明の黄斑下滲出が生じた症例の報告。症例：33歳男性が7日前からの右眼の深部痛と霧視で受診した。生来健康であり，格別の疾患歴はなく，職業は海上自衛隊員であった。6週間前にウシの肝臓を生食していた。所見と経過：矯正視力は右30cm指数弁，左1.5であった。右眼に結膜と毛様充血，前部ぶどう膜炎の所見があり，黄斑下に出血と滲出を伴う黄白色の隆起性病変があった。3日間の抗真菌薬投与で病変が悪化し，アセチルスピラマイシンとプレドニゾロンの内服に切り替えた。2日後から黄斑下滲出の吸収がはじまり，初診から2週間後に網膜下液は消失し，前眼部の炎症はなくなった。5か月後に黄斑部の病変は瘢痕化し，0.1の視力を得た。ウイルス，トキソプラズマ，サルコイドーシス感染などを示す検査はすべて陰性であった。結論：初診時からトキソプラズマ感染が疑われ，抗トキソプラズマ薬の投与後に病状が急速に軽快したが，この可能性を支持する諸検査は得られなかった。

Abstract.　Purpose：To report a case with idiopathic submacular exudation. Case：A 33-year-old male presented with pain and blurring in his right eye since 7 days before. He had no history of systemic or eye disease. He has been serving in the navy. He had eaten raw beef liver 6 weeks before. Findings and Clinical Course：His corrected visual acuity was counting fingers right and 1.5 left. His right eye showed hyperemia,signs of iritis,and submacular exudation with hemorrhage. The findings progressed during 3 days of treatment with antifungal agent. Switching to peroral acetylspiramycin and prednisolone was followed by decrease of submacular lesion 2 days later. Submacular exudation and iritis disappeared 2 weeks later. The macular lesion turned into scarring with visual acuity of 0.1 5 months later. Laboratory studies were negative suggesting viral infection,toxoplasmosis,or sarcoidosis. Conclusion：The present case showed signs suggesting ocular toxoplasmosis from the onset. No evidences were present to support this assumption,possibly because of rapid progression of the disease.