von Hippel-Lindau病に合併した黄斑円孔術後に水痘帯状疱疹ウイルス虹彩毛様体炎を生じた1例

Varicella zoster virus iridocyclitis following macular hole surgery in a case of von Hippel-Lindau disease

要約　目的：黄斑円孔術後に水痘帯状疱疹ウイルス虹彩毛様体炎が生じたvon Hippel-Lindau病の症例の報告。症例：41歳男性が右眼視力低下で受診した。31歳当科初診時，両眼に網膜血管腫があり，光凝固が行われた。矯正視力は2か月前まで良好であった。10年前の両腎摘出以後血液透析中であり，39歳で小脳血管芽腫摘出術を受けた。父，弟，子にvon Hippel-Lindau病がある。所見：矯正視力は右0.1，左1.5であった。右眼に黄斑上膜と黄斑円孔があり，硝子体手術を行った。その6日後に前房の炎症が増悪し，前房水から水痘帯状疱疹ウイルスが検出された。単純ヘルペスウイルスとサイトメガロウイルスは陰性であった。バラシクロビルの内服で消炎した。結論：von Hippel-Lindau病での眼手術後には，炎症所見の経過に配慮する必要がある。

Abstract.　Purpose：To report a case of von Hippel-Lindau disease who developed varicella-zoster virus iridocyclitis after vitreous surgery for macular hole. Case：A 41-year-old male presented with impaired visual acuity in his right eye since a few weeks before. He had been diagnosed with retinal hemangioblastoma and been treated by photocoagulation at the age of 31 years. He had received removal of both kidneys at the same age and been receiving hemodialysis. Resection of cerebellar hemangioblastoma had been performed 2 years before. His father,brother and daughter had been diagnosed with von Hippel-Lindau disease. Findings：Corrected visual acuity was 0.1 right and 1.5 left. The right eye showed epiretinal membrane with macular hole and received vitreous surgery. Inflammation in the anterior chamber exacerbated 6 days later. Aspirated aqueous was positive for varicella-zoster virus and negative for herpes simplex virus or cytomegalovirus. The iridocyclitis subsided after systemic valaciclovir. Conclusion：This case illustrates that utmost care is needed after surgery in patients with von Hippel-Lindau disease.