眼窩筋炎の治療に血清補体価測定が有用であった1例

A case of ocular myositis guided by serous complement level in its treatment

要約　目的：眼窩筋炎の治療に血清補体価が有用であった1症例の報告。症例：62歳男性が眼痛で受診した。霧視と視野障害を訴え，名古屋大学病院で検査を行っていたが，訴えに見合う所見は得られていなかった。糖尿病網膜症に対して右眼の光凝固，両眼の白内障手術の既往があった。所見：矯正視力は両眼とも0.03で，糖尿病網膜症があったが，中心窩厚は正常範囲にあった。視覚障害の一部は心因性であることが示唆された。眼痛時，結膜充血，浮腫，眼球運動障害を呈し，画像検査で外眼筋の肥厚があったため，眼窩筋炎と診断した。プレドニゾロン内服で眼痛が消失し，減量で再発した。シクロスポリンAを併用し，プレドニゾロンを減量した。訴えが誇張される傾向があったため血清補体価（CH50）から炎症の状態を確認した。CH50の値はプレドニゾロンの量，痛みの変動と同期した。結論：CH50は，眼窩筋炎の活動性の推定とプレドニゾロンの減量の指針として有用であった。

Abstract.　Purpose：To report a case of ocular myositis treated with serum compliment value（CH50）monitoring in assessing the state of inflammation. Case：A 62-year-old male visited Nagoya university hospital complaining of ocular pain. He has been examined regarding blurred vision and visual field disturbance,although the physical findings contradicted his visual complaint. He had a history of photocoagulation in his right eye due to diabetic retinopathy and bilateral cataract surgeries. Findings：Corrected visual acuity was 0.03 in either eye. Both eyes showed diabetic retinopathy. Foveal thickness was within normal limits. The findings suggested that a part of his impairment might be functional. He showed hyperemia,chemosis,and eye movement limitation in both eyes. Diagnostic imaging showed hypertrophy of extraocular muscles suggestive of optic myositis. Ocular pain ceased after administrating peroral predonisolone and recurred after reduction of dosage. Cyclosporine A was added to prevent recurrence when the PSL was reduced. CH50 levels were periodically examined to determined PSL reduction,because the patient's symptoms were deemed unreliable. The value fluctuated depending on the dose of PSL and amount of pain. Conclusion：Serum level of CH50 was useful in assessing the activity of ocular myositis and in determining the correct dosage of predonisolone.