眼球後壁の肥厚をきたし視力予後不良であった結核性ぶどう膜炎の1例

A case of tuberculous uveitis with thickened posterior eye wall and poor visual outcome

要約　目的：視力の経過が不良であった結核性ぶどう膜炎の症例の報告。症例：47歳女性が6週間前からの右眼と眼球後方の疼痛で受診した。旧国籍はフィリピンで，19年前から日本に住んでいる。所見：視力は右手動弁，左1.5で，右眼に毛様充血，前房内炎症，虹彩後癒着，硝子体混濁，網膜静脈の拡張と蛇行，乳頭発赤があり，超音波検査で眼球後壁の肥厚があった。ツベルクリン反応が強陽性で，鎖骨上窩リンパ節の生検で乾酪壊死を伴う類上皮細胞肉芽腫があり，頸部リンパ節結核に伴う汎ぶどう膜炎と診断した。プレドニゾロン内服と抗結核治療を行った。1か月後に網膜電図が無反応となり，牽引性網膜剝離を伴う増殖性硝子体網膜症が生じ，右眼視力は光覚なしとなった。結論：結核はぶどう膜炎の原因の1つであり，早期診断と治療が肝要である。

Abstract.　Purpose：To report a case of tuberculous uveitis with poor visual outcome. Case：A 47-year-old woman presented with pain in and behind the right eye since 6 weeks before. She had grown up in Philippines before coming to Japan 19 years before. Findings：Visual acuity was hand motion right and 1.5 left. The right eye showed ciliary injection, signs of inflammation in the anterior chamber, posterior synechia, vitreous opacity, dilatation and tortuosity of retinal veins, and hyperemic optic disc. Ultrasonography showed thickened posterior eye wall. She was strongly positive to tuberculin test. Biopsy of cervical lymphnodes showed findings of infection by Mycobacterium tuberculosis, leading to the diagnosis of tuberculous uveitis. She received antituberculous medication and oral prednisolone therapy. Electroretinogram became flat one month after her initial visit. The right eye became blind due to tractional retinal detachment with proliferative vitreoretinopathy. Conclusion：This case illustrates that tuberculosis is still a possible cause of uveitis. Early identification and management for tuberculous uvietis is required for good prognosis.