甲状腺眼症に対するステロイドパルス療法中に急性肝機能障害を認めた1例

Acute hepatic dysfunction in a case during pulsed corticosteroid therapy for thyroid ophthalmopathy

要約　目的：甲状腺眼症に対するステロイドパルス療法中に急性肝機能障害が生じた1症例の報告。症例：38歳女性が4か月前にBasedow病と診断され，眼科を受診した。視力は左右とも1.5で，眼位と眼球運動に障害はなく，上眼瞼腫脹があった。21か月後の磁気共鳴画像検査（MRI）では上直筋と内直筋の腫脹が増大した。メチルプレドニゾロン1gを3日間投与し，4日間休薬するパルス療法を3回行った。その後のプレドニゾロン内服中に，肝酵素の著明な上昇がみられた。幸い肝機能障害の臨床症状はなく，プレドニゾロンの早期減量で肝酵素も正常化した。結論：甲状腺眼症に対するステロイドパルス療法は，急性肝機能障害を起こす危険があり，慎重に行うべきである。

Abstract.　Purpose：To report a case who developed acute hepatic dysfunction during pulsed corticosteroid therapy for thyroid ophthalmopathy. Case：A 38-year-old female had been diagnosed with Graves disease 4 months before. Visual acuity was 1.5 in either eye. She showed normal eye position and movements with swollen upper eyelid. Both eyes showed increased swelling of superior and medial rectus muscle by magnetic resonance imaging（MRI）. Pulsed corticosteroid therapy was started consisting of 3 days of 1g methylprednisolone followed by 4 days of no medication. After 3 courses,liver enzymes acutely increased during peroral prednisolone treatment. Clinical findings for liver failure were consistently absent. Liver enzymes were normalized after early reduction of peroral prednisolone. Conclusion：Acute liver dysfunction may develop following pulsed corticosteroid therapy for thyroid ophthalmopathy.