両眼で同時に乳頭血管炎を発症した1例

A case of vasculitis of the optic disc with simultaneous bilateral onset

要約　目的：両眼に同時に発症した乳頭血管炎の症例の報告。症例：63歳女性が1週間前からの右眼視力低下で受診した。11年前にIgA腎症と診断され，6年前から糸球体腎炎で腹膜透析を受けていた。所見：矯正視力は右0.4，左1.0で，右眼の黄斑部に赤い隆起性病変と網膜下出血があった。右眼のポリープ状脈絡膜血管症と診断した。10か月後に左眼の視力が0.5に低下した。両眼に出血を伴う乳頭の発赤腫脹があった。両眼のⅠ型乳頭血管炎と診断し，プレドニゾロン30mg/日の内服を開始した。左眼視力は5週間後に1.2に回復した。結論：本症例では基礎疾患として，自己免疫性のIgA腎症が存在し，乳頭血管炎の発症に免疫学的な機序が関与した可能性がある。

Abstract.　Purpose：To report a case of bilateral optic disc neuritis that improved after peroral corticosteroid. Case：A 63-year-old female presented with impaired visual acuity since one week before. She had been diagnosed with IgA nephropathy 11 years before. She had been receiving peritoneal dialysis since 6 years before for chronic glomerulonephritis. Findings：Corrected visual acuity was 0.4 right and 1.0 left. The right eye showed orange-red elevated lesion in the macula with subretinal hemorrhage. She was diagnosed with polypoid choroidal vasculopathy. Left visual acuity decreased to 0.5 10 months later. Both eyes showed swelling and hyperemia of optic disc associated with hemorrhage. She was diagnosed with bilateral type Ⅰoptic disc vasculitis. Left visual acuity improved to 1.2 after 5 weeks of peroral prednisolone at the daily dosis of 30 mg. Conclusion：IgA nephropathy is regarded as an autoimmune disease. There is a possibility that immunological disorder was involved in the pathogenesis of optic disc vasculitis in this patient.