寄生虫性網膜囊胞症に対し硝子体手術を施行した1例

A case of intraocular cysticercosis treated by vitreous surgery

要約　目的：寄生虫による網膜囊胞症の症例の報告。症例：24歳男性が4か月前からの急激な左眼視力低下で受診した。東アフリカのマラウィに2年間滞在し，帰国直後に視力障害が生じた。他医での検査で，IgE値と有鉤囊虫抗体値が上昇していた。所見と経過：矯正視力は右1.2，左0.6で，左眼黄斑部に黄白色病巣があり，硝子体の下方に白色の球体があった。硝子体手術で黄斑部の病巣と白色球体を切除し，シリコーンオイル充填を行った。摘出標本には虫体は証明されなかった。内科的検索で小腸に長い扁平な虫体が確認され，有鉤条虫と判定された。0.1の最終視力が得られた。結論：寄生虫による網膜囊胞症の初期には鑑別診断が困難な事例がある。通常とは異なる所見と経過や患者背景に留意し，血液検査や寄生虫の抗体検査を行う必要がある。

Abstract.　Purpose：To report an unusual case of ocular cysticercosis. Case：A 24-year-old male presented with acute visual loss in his left eye since 4 months before. He had been staying in Malawi in eastern Africa for humane activities for 2 years. He had reportedly elevated values of IgE and anticysticercus antibody before visiting us. Findings：Corrected visual acuity was 1.2 right and 0.6 left. His left eye showed a yellowish lesion in the macula and a white spheric floater in the vitreous. Both lesions were removed by vitreous surgery. Removed specimens showed no organism. During follow-up in the department of medicine,a long and flat organism was detected in the intestine which was later identified as a variant of Taenia solium. He had final visual acuity of 0.1. Conclusion：Intraocular cysticercosis may be difficult to diagnose in its early stage. Due attention is advocated to unusual findings and patient's background as well as hematological and immunological studies.