21年後に再発した原田病の1例

A case of Vogt-Koyanagi-Harada disease with recurrence twenty-one years later

要約　目的：初発から21年後に再発した原田病の症例の報告。症例：33歳女性が7日前からの変視症と霧視で受診した。矯正視力は右0.1，左0.4で，両眼の後極部一帯に多発性漿液性網膜剝離があった。髄液に細胞過多はなかった。後眼部型の原田病と診断し，プレドニゾロン初回量200mgの静注で網膜剝離は消失し，以後の経過は良好であった。再発：21年後の54歳のとき，右眼に霧視を自覚し，7日後に受診した。矯正視力は右0.6，左1.0で，右眼に毛様充血，前房内細胞，Koeppe結節があり，肉芽腫性前部ぶどう膜炎の所見を呈した。両眼とも夕焼け状眼底で，網膜剝離や乳頭発赤はなかった。片眼性の原田病の再発と考え，ステロイド薬の点眼とテノン囊下注を行った。病変は治癒し，以後5か月後の現在まで経過は良好である。結論：いったん治癒した原田病が長期間後に再発することがある。本症例では両眼の後部ぶどう膜炎として発症し，21年後に片眼の前部ぶどう膜炎として再発した。

Abstract.　Purpose：To report a case of Vogt-Koyanagi-Harada（VKH）disease that recurred 21 years later. Case：A 33-year-old female visited us for metamorphopsia and blurring since 7 days before. Her corrected visual acuity was 0.1 right and 0.4 left. Both eyes showed multiple serous retinal detachment in the macular area. Cerebrospinal fluid showed no pleocytosis. She was diagnosed with posterior-type VKH disease. Treatment with intravenous prednisolone at the daily dosis of 200 mg was followed by disappearance of retinal detachment. Recurrence：The patient noticed blurring in her right eye at the age of 54 years,or 21 years after the episode. When seen 7 days later,her corrected visual acuity was 0.6 right and 1.0 left. The right eye showed ciliary injection,cells in the aqueous,and Koeppe nodules on the iris as typical signs of granulomatous anterior uveitis. Both eyes showed sunset-glow fundus without retinal detachment or disc hyperemia. She was diagnosed with unilateral VKH disease. Treatment with topical corticosteroid was followed by cure of uveitis in the right eye. She has been doing well for 5 months until present. Conclusion：This case illustrates that VKH disease may recur after a long interval. This case is characterized by bilateral posterior uveitis during the initial episode and by unilateral anterior uveitis at the recurrence.