肥厚性硬膜炎に伴う視神経障害の治療中に大腸癌の多発肝転移が発見された1例

Corticosteroid pulse therapy was effective for optic neuropathy in a case of hypertrophic pachymeningitis

要約　目的：副腎皮質ステロイドのパルス療法が，肥厚性硬膜炎に併発した視神経症に奏効した1例の報告。症例：48歳女性が1週間前からの右眼霧視で受診した。所見：矯正視力は左右眼とも1.5で，眼科的には格別の異常はなかった。2か月後に右眼の霧視が悪化し，複視が生じた。右外転神経麻痺があり，ガドリニウム造影を併用した磁気共鳴画像検査で，肥厚性硬膜炎と診断された。ステロイド薬の内服で複視を含む神経症状は寛解したが，その10か月後に右視力が0.07に低下し，中心暗点が生じた。ステロイドパルス療法で4週間後に中心暗点は消失したが，開始から2か月後に肝転移を伴う大腸癌が発見された。以後4か月間の現在まで，眼病変を含む神経症状の再発はない。結論：ステロイドのパルス療法が，肥厚性硬膜炎に併発した視神経症に奏効した。

Abstract.　Purpose：To report a case of pachymeningitis with optic nerve involvement that responded to pulsed corticosteroid therapy. Case：A 48-year-old female presented with blurring in the right eye since one week before. Corrected visual acuity was 1.5 in either eye. She was free of abnormal ophthalmological findings. She developed right abducens palsy 2 months later. Magnetic resonance imaging led to the diagnosis of pachymeningitis. Peroral corticosteroid was followed by improved neurological findings. The right visual acuity decreased to 0.07 with central scotoma another 10 months later. Pulsed corticosteroid therapy was followed by improved visual acuity 4 weeks later. Colon carcinoma with metastasis to the liver was detected 2 months after the episode. There has been no recurrence for 4 months until present. Conclusion：Pulsed corticosteroid therapy was effective for optic neuropathy in a case of pachymeningitis.