結核治療直後にみられた網膜静脈周囲炎の1例

A case of retinal periphlebitis during systemic treatment for tuberculosis

要約　目的：結核性リンパ腺炎に対する6か月間の抗結核治療中に網膜静脈周囲炎が生じた症例の報告。症例と所見：42歳男性が視力障害で受診した。6か月前に頸部リンパ腺が腫脹した。生検で結核性リンパ腺炎と診断され，4剤併用による抗結核療法を受けていた。矯正視力は右1.5，左1.2で，左眼に軽度の硝子体混濁があった。1か月後に両眼の眼底周辺部に網膜出血，左眼に網膜血管の白線化が生じた。網膜静脈周囲炎と診断し，プレドニゾロンと抗結核薬3剤の内服を始めた。5か月後に網膜の無血管領域にレーザー光凝固を行い，以後の経過は良好である。結論：結核に対する全身治療中に結核性網膜静脈周囲炎が生じる可能性があり，眼底所見に留意する必要がある。

Abstract.　Purpose：To report a case of tuberculous lymphadenitis who developed retinal periphlebitis after 6 months of antituberculous treatment. Case and Findings：A 42-year-old male presented with impaired visual acuity. He had been diagnosed with tuberculous lymphadenitis in the neck by biopsy and had been receiving four medications since 6 months before. His corrected visual acuity was 1.5 right and 1.2 left. The left eye showed vitreous hemorrhage. Both eyes developed retinal hemorrhage with vascular sheathing in the left fundus one month later. He was treated with peroral prednisolone and three antituberculous medications. He received laser photocoagulation for avascular retina 5 months later. He has been doing well for 15 months until present. Conclusion：This case illustrates that retinal periphlebitis may develop during systemic treatment for tuberculosis.