急性網膜色素上皮炎様所見を合併した急性後部多発性斑状色素上皮症の1例

A case of acute posterior multifocal placoid pigment epitheliopathy（APMPPE）simulating acute retinal pigment epitheliitis

要約　目的：急性網膜色素上皮炎に似た所見を呈した急性後部多発性斑状色素上皮症（APMPPE）の症例の報告。症例：16歳男性が1週間前からの左眼視力低下で受診した。所見：矯正視力は右1.5，左0.6で，両眼に淡い滲出斑が網膜下に散在していた。蛍光眼底造影所見からAPMPPEと診断した。多数の暗灰色点が左眼黄斑部の深層にあり，黄白色輪に囲まれていた。左眼黄斑部は地図状の低蛍光を呈し，光干渉断層計で視細胞内外節の欠損と脈絡膜の高輝度の陰影があった。この所見は急性網膜色素上皮炎に相当すると解釈した。無治療で2か月後に滲出斑は消失し，蛍光眼底造影と光干渉断層計所見は改善し，左眼視力は1.2になった。結論：APMPPEに急性網膜色素上皮炎に似た病変が併発する可能性がある。

Abstract.　Purpose：To report a case of acute posterior multifocal placoid pigment epitheliopathy（APMPPE）associated with acute retinal pigment epitheliitis（ARPE）. Case：A 16-year-old male presented with impaired vision in the left eye since one week before. Findings：Corrected visual acuity was 1.5 right and 0.6 left. Both eyes showed numerous creamy patches at the subretinal level. Findings by fluorescein angiography led to the diagnosis of APMPPE. The left eye showed multiple grey spots at the level of retinal pigment epithelium surrounded by yellowish halo in the macular area. Fluorescein angiography showed hypofluorescence in a geographic pattern. Optical coherence tomography（OCT）showed dark choroid and findings suggestive of defect in the junction of inner and outer photoreceptor segments in the macula. These findings were consistent with the diagnosis of ARPE. The fundus lesions spontaneously disappeared 2 months later associated with normalization of visual acuity,fluorescein angiographic and OCT findings. Conclusion：This case illustrates that APMPPE may manifest macular lesions simulating ARPE.