外傷後に高度な滲出性網膜剝離を呈した小児原田病の1例

A child with Harada disease manifesting severe exudative retinal detachment following trauma

要約　目的：原田病で両眼に高度な滲出性網膜剝離を呈した小児の報告。症例：7歳女児が3週間前からの両眼の視力低下と充血で受診した。眼症状が生じる前日に顔面を打ち，歯肉に受傷した。所見：矯正視力は左右とも0.03で，両眼に球結膜の充血，前房混濁，虹彩後癒着，高度の滲出性網膜剝離があった。点眼治療は本人が拒否し，6日後に左右とも視力が手動弁になった。ベタメタゾン点眼を開始し，9日後からプレドニゾロン内服を始めた。10週間後に網膜剝離は消失し，視力は右0.6，左0.3になり，夕焼け眼底，白髪，背中の白斑が生じた。以後虹彩炎の再発があったが，初診から14か月後に消炎し，右0.3，左0.4の最終視力を得た。結論：10歳以下では稀であるが，本症例は原田病と診断され，プレドニゾロンの全身投与が奏効した。外傷との関係は不明である。

Abstract.　Purpose：To report a child with Harada disease who manifested severe exudative retinal detachment in both eyes. Case：A 7-year-old girl presented with impaired vision and hyperemia in both eyes since 3 weeks before. She had suffered from trauma affecting the gingival on the day before onset of eye problems. Findings：Corrected visual acuity was 0.03 in either eye. Both eyes showed hyperemia,turbid aqueous,posterior synechia and severe retinal detachment. Topical medication was prescribed but not used by the patient. Visual acuity decreased to hand motion in both eyes 6 days later. Both eyes were treated by topical betamethasone and peroral prednisolone. Retinal detachment disappeared 10 weeks after start of treatment with visual acuity of 0.6 right and 0.3 left. Both eyes showed sunset-glow fundus. She showed alopecia and patchy leukoderma. Signs of inflammation subsided 14 months after onset. Conclusion：The present case was diagnosed with typical Harada disease. Systemic corticosteroid appeared to be effective. Association between trauma and Harada disease is not clear.