乳頭浮腫と虹彩毛様体炎を合併した成人発症Still病の1例

A case of adult-onset Still disease with iritis and papilledema

要約　目的：両眼に虹彩毛様体炎と乳頭浮腫が生じた成人発症Still病の症例の報告。症例：16歳女性が両眼の結膜充血で受診した。3か月前に発熱して全身に皮疹が生じ，川崎病と診断された。膝関節痛と腫脹が2週間前から生じた。所見：矯正視力は左右とも1.2で，両眼に軽度の虹彩毛様体炎の所見と乳頭浮腫があった。成人発症Still病と診断した。全身的にプレドニゾロンとメトトレキサートを投与し，ベタメタゾンを点眼した。虹彩毛様体炎は寛解し，乳頭浮腫は軽快した。乳頭浮腫と乳頭神経線維層が軽快する過程の評価には，光干渉断層計により数値化した資料が有用であった。結論：成人発症Still病では，稀ではあるが虹彩毛様体炎や乳頭浮腫が生じることがある。

Abstract.　Purpose：To report a case of bilateral iridocyclitis and papilledema that led to the diagnosis of adult-onset Still disease. Case：A 16-year-old female presented with hyperemia in both eyes. She had had fever followed by skin eruption and been diagnosed with Kawasaki disease. She had had pain and selling in the knee joints since 2 weeks before. Findings：Corrected visual acuity was 1.2 in either eye. Both eyes showed findings of moderate iridocyclitis and papilledema. She was diagnosed with adult-onset Still disease. She was treated by prednisolone,methotrexate and massive infusion of betamethasone. The treatment was followed by cure of iridocyclitis and improvement of papilledema. Optical coherence tomography was useful in the objective evaluation of the changing state of optic disc and neural components of the retina. Conclusion：This case illustrates that iridocyclitis and papilledema may be associated with adult-onset Still disease.