Vogt-小柳-原田病の治療中に融合する白斑が多発し視力が回復した1例

A case of Vogt-Koyanagi-Harada disease manifesting multiple white dots with ultimate visual recovery

要約　目的：Vogt-小柳-原田病の経過中に白斑が多発し，視力が回復した1症例の報告。症例：30歳女性は，眼症状の3日前からの感冒様症状，頭痛，歪視を自覚していた。矯正視力は右0.15，左0.07で，両眼に軽度の角膜後面沈着物と，漿液性網膜剝離を認めた。感音性難聴と髄液にリンパ球の増加があり，Vogt-小柳-原田病と診断し，プレドニゾロン大量療法を開始した。治療開始から9日後に網膜剝離は改善したが，白色斑が明瞭になった。フルオレセイン蛍光眼底造影で白色斑の部位は初期には低蛍光，造影後期に過蛍光を示した。白色斑はその後灰白色になり，矯正視力は右0.9，左1.0に回復した。頭部の脱毛がその後に生じた。結論：Vogt-小柳-原田病の本症例で生じた眼底の白斑は，地図上脈絡膜炎やacute posterior multifocal placoid pigment epitheliopathy（APMPPE）に類似していた。これら3疾患が近接した病態にあることが推測された。

Abstract.　Purpose：To report a case of Vogt-Koyanagi-Harada（VKH）disease who manifested multiple white dots during the course of recovery with ultimate visual recovery. Case：A 30-year-old female was referred to us for headache, metamorphopsia, and symptoms simulating common cold. Corrected visual acuity was 0.15 right and 0.07 left. Both eyes showed serous retinal detachment. She also showed sensorineural deafness and pleocytosis in the spinal fluid. These findings lead to the diagnosis of VKH disease. Nine days after start of megadosis of prednisolone, retinal detachment disappeared followed by appearance of white dots. By fluorescein angiography, the dots showed hypofluorescence in the initial phase and hyperfluorescence in the late phase. The dots later turned into gray ones. Visual acuity recovered to 0.9 right and 1.0 left. Alopecia appeared later. Conclusion：White dots in the present case of VKH disease appeared similar to those in serpiginous choroiditis or acute posterior multifocal placoid pigmentopathy. There is a possibility that these three fundus diseases may have causative mechanisms in common.