前房水PCRでHSV（初診時）とアスペルギルス（再燃時）が検出された片眼性網膜血管炎の1例

A case of unilateral retinitis positive for herpes simplex virus initially and for Aspergillus during recurrence in the aqueous by polymerase chain reaction

要約　目的：前房水のポリメラーゼ連鎖反応（PCR）による検索で治療方針が決定した急性網膜血管炎の症例の報告。症例：28歳女性が右眼視力の急激な低下で受診した。妊娠9か月であった。所見：矯正視力は右0.5，左1.2で，右眼の前房に炎症の所見，硝子体混濁，網膜血管炎があった。前房水のPCRで単純ヘルペスウイルス（HSV）が陽性であり，アシクロビルとプレドニゾロンを投与した。3週間後に正常に出産した。初診から5か月後に右眼視力が0.03に低下し，前房に炎症，硝子体混濁，網膜血管炎の所見が生じた。前房水のPCRではHSVが陰性で，血液のPCRでアスペルギルスが陽性であった。ボリコナゾールなどの全身投与で眼所見は寛解し，視力は1.2に改善した。初診から12か月後に眼炎症が再発したが，前房水と血液のPCR所見は陰性であり，プレドニゾロン増量などで軽快した。結論：非典型的な網膜血管炎の診断と治療方針の決定に，前房水のPCR検査が有用であった。

Abstract.　Purpose：To report a case of acute retinal vasculitis in whom polymerase chain reaction（PCR）was useful in the diagnosis. Case：A 28-year-old female presented with acute impairment of vision in the right eye. She was at 9 months of pregnancy. Findings：Corrected visual acuity was 0.5 right and 1.2 left. The right eye showed signs of inflammation in the anterior chamber, vitreous opacity, and retinal vasculitis. Aqueous humor was positive for herpes simplex virus（HSV）by PCR. She was treated by systemic acyclovir and prednisolone followed by improvement. She gave normal birth 3 weeks later. Right visual acuity decreased to 0.03 five months later with similar ocular manifestations. Aqueous humor was negative for HSV by PCR. The peripheral blood was positive for Aspergillus by PCR. Treatment with systemic voriconazole was followed by remission with visual acuity recovering to 1.2. Another flare-up occurred 12 month after the initial episode. Aqueous humor and peripheral blood was negative by PCR. Systemic prednisolone was followed by remission. Conclusion：PCR of aqueous humor was useful in the diagnosis of atypical acute retinal vasculitis.