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要約 目的:プロピルチオウラシル内服により抗好中球細胞質抗体(ANCA)関連血管炎が生じ,両眼の球後視神経炎が発症した症例の報告。症例:47歳女性が1週間前からの両眼視力障害と頭痛を伴う球後痛で紹介され受診した。Basedow病があり,3年2か月前からプロピルチオウラシルを内服していた。2年前に両下肢に皮疹が生じ,ANCA関連血管炎と診断され,内服を中止した。2か月前にプロピルチオウラシル内服を再開したが,6週後に頭痛と発熱が生じ,服薬を中止した。所見:矯正視力は右0.01,左0.03で,両眼に中心暗点があった。MRIで視神経鞘の増強があり,両眼の球後視神経炎と診断した。ステロイドパルス療法で3日後に中心暗点が消失し,両眼の視力が1.2に改善した。結論:本症例の球後視神経炎はプロピルチオウラシル内服によるANCA関連血管炎が原因であったと判断される。
Abstract. Purpose:To report a case of bilateral retrobulbar neuritis as manifestation of anti-neutrophil cytoplasm circulating antibody(ANCA)-associated vasculitis following systemic propylthiouracil. Case:A 47-year-old woman presented with bilaterally impaired vision with headache since one week before. She had been treated with peroral propylthiouracil for Graves disease since 38 months before. The treatment was discontinued 24 months before for skin eruption due to ANCA-related vasculitis. The treatment was started again 2 months before and was discontinued 6 weeks later for headache and fever. Findings:Corrected visual acuity was 0.01 right and 0.03 left. Both eyes showed central scotoma. Magnetic resonance imaging(MRI)showed enhanced optic nerve sheath, leading to the diagnosis of bilateral retrobulbar neuritis. Pulsed corticosteroid therapy was followed by visual acuity of 1.2 in either eye 3 days later. Conclusion:This case illustrates that retrobulbar neuritis may be induced by ANCA-associated vasculitis following systemic propylthiouracil.
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