眼瞼Kaposi肉腫を契機にHIV感染が発見され免疫再構築症候群をきたした1例

Immune reconstitution syndrome in an HIV-positive patient with Kaposi sarcoma in the eyelid as the initial manifestation

要約　目的：眼瞼Kaposi肉腫を契機にヒト免疫不全ウイルス（HIV）感染が発見され，抗癌化学療法で改善したのち，免疫再構築症候群が生じた症例の報告。症例と経過：39歳男性が左眼瞼腫脹で受診した。精査によりKaposi肉腫と診断し，HIV感染であることが判明した。抗癌化学療法で眼瞼腫脹は軽快したが，多剤併用療法の開始後に眼瞼腫脹が再燃した。免疫再構築症候群と診断し，抗癌化学療法を再開して寛解が得られた。結論：本症例は，難治性の眼瞼周囲の皮疹がKaposi肉腫であり，多剤併用療法の開始後に免疫再構築症候群が生じうることを示している。

Abstract.　Background：To report a case who showed Kaposi sarcoma in the eyelid leading to the detection of infection by human immunodeficiency syndrome（HIV）and who developed immune reconstitution syndrome during the course of treatment. Case and Findings：A 39-year-old male presented with swelling of left eyelid. He was found to be positive to HIV antibody. Eyelid swelling improved following cancer chemotherapy but recurred after start of highly active antiretroviral therapy（HAART）. He was diagnosed with immune reconstitution syndrome. Cure was obtained after re-introduction of cancer chemotherapy. Conclusion：This case illustrates that Kaposi sarcoma may manifest as eyelid swelling, be associated with HIV infection, and result in immune reconstitution syndrome during the course of treatment.