点眼治療のみで軽快した壊死性強膜炎の1例

A case of necrotizing scleritis cured by topical treatment only

要約　目的：点眼治療のみで軽快した壊死性強膜炎の症例の報告。症例：79歳男性が左眼の眼脂と充血で受診した。15年前から関節リウマチで加療中であり，前日から汎血球減少を伴う熱発と皮疹があった。所見：左眼の鼻側上方で強膜が菲薄・融解し，ぶどう膜が透見され，壊死性強膜炎と診断した。全身状態から副腎皮質ステロイドや免疫抑制薬の全身投与が不可能であり，ベタメタゾンと2％シクロスポリンの点眼を中心に治療を行った。治療開始から3週間後に強膜と結膜の炎症が鎮静化した。結論：全身的な理由から副腎皮質ステロイドの全身投与ができない壊死性強膜炎では，ベタメタゾンやシクロスポリンの点眼のみで軽快する症例がある。

Abstract.　Purpose：To report a case of necrotizing keratitis that subsided with topical treatment only. Case：A 79-year-old male presented with hyperemia and discharge in the left eye. He had been treated for rheumatoid arthritis since 15 years before. He had had pancytopenia with fever and skin eruption since the day before. Findings：The left eye showed thinning and melting of sclera in the superior nasal sector. The uvea was visible through the necrotic sclera. He was diagnosed with necrotizing keratitis. Systemic corticosteroid or immunosuppressive agent was contraindicated due to his systemic status. The left eye was treated by topical instillation of betamethasone and 2％ cyclosporine. Inflamatory signs of sclera and conjunctiva subsided after 3 weeks of treatment. Conclusion：The present case illustrates that necrotizing scleritis may be brought to remission by topical treatment with betamethasone and cyclosporine only.