妊娠14週でステロイドパルス療法を施行した原田病の1例

Pulsed corticosteroid therapy for Vogt-Koyanagi-Harada disease in a case at fourteen weeks' gestation

要約　目的：妊娠14週の女性に発症した原田病にステロイドパルス療法が奏効した報告。症例：31歳女性が3日前からの頭痛を伴う両眼の変視と視力低下で受診した。妊娠14週4日であった。所見と経過：矯正視力は右0.9，左1.0で，右眼に＋2.5D，左眼に＋0.75Dの遠視があった。前眼部に炎症所見はなく，両眼の眼底に漿液性網膜剝離があり，原田病と診断した。胎児に対する危険が大きい妊娠12週を過ぎているので，メチルプレドニゾロン1,000mg/日によるパルス療法を3日間行い，4日目からプレドニゾロン25mgの内服に切り替えた。治療開始から12日で漿液性網膜剝離は消失し，近視化した。妊娠38週4日で出産し，母子に異常はなく，13か月後の現在まで問題はない。結論：妊婦に発症した原田病に対し，眼外症状を重視したステロイドのパルス療法が奏効した。

Abstract.　Purpose：To report pulsed corticosteroid therapy for Vogt-Koyanagi-Harada（VKH）disease in a woman at fourteen weeks' gestation. Case：A 31-year-old woman presented with headache, bilateral blurring and metamorphopsia since 3 days before. She was pregnant at the gestation of 14 weeks 4 days. Findings：Corrected visual acuity was 0.9 right and 1.0 left. Both eyes were hyperopic at ＋2.5D right and ＋0.75D left. The anterior chamber was free of inflammatory findings. Both eyes showed serous retinal detachment. She was diagnosed with VKH disease. As her pregnancy was over 12 weeks regarded as risky for the fetus, she was treated by pulsed steroid therapy at the initial dosis of 1,000 mg methylprednisolone per day. The treatment was switched to peroral prednisolone 25 mg per day from the 4th day on. Serous retinal detachment disappeared on day 12 of treatment with both eyes becoming myopic. She gave normal birth at 38 weeks 4 day of gestation. She and her infant have been doing well for 13 months until present. Conclusion：Pulsed steroid therapy was safe and effective for VKH disease in an expectant mother.