桐沢型ぶどう膜炎の2症例

Two cases of Kirisawa-type uveitis

　硝子体混濁が比較的軽かった，片眼性の桐沢型ぶどう膜炎の2例を経験した．症例1は55歳男性，成人T細胞性白血病の患者で，日和見感染の既往があった．症例2は41歳の健康男子で，ステロイドやアシクロビールによる治療も奏効せず，網膜剥離へと進展した．リンパ球サブセット分析にて免疫異常が示唆された．2症例とも急性期に点状，一部斑状の滲出斑がみられ，眼底所見，螢光眼底所見よりこの滲出斑は本症に特徴的な濃厚な滲出斑とは本態の異なる病巣と考えられた．また，濃厚は滲出斑は三面鏡検査にて剥離網膜下の顆粒状堆積物として観察され，その主体は脈絡膜よりの炎症性滲出物と考えられた．

　本症の最大の特徴は，網膜内ウイルスに対する異常な反応性ぶどう膜炎にあると思われ，その原因として免疫応答の異常を推測した．

We treated two cases with Kirisawa-type uveitis. The condition was unilateral and was associated with minimal vitreous opacity in both cases. The first case, a 55-year-old male, had been suffering from adult T-cell leukemia for the past 5 years and from cryptococcal meningitis and pneumocystis-carinii pneumonia as opportunistic infections. The second case was an apparently healthy 41-year-old male. He was treated with systemic corticosteroid and acyclovir, but developed retinal detachmentlater. Analysis of lymphocyte subsets in the circulat-ing blood suggested immunological deficiencies.Punctate or macular retinal exudates were obser-ved during the acute stage in both cases. These lesions seemed to be different from dense yellowish-white exudates that are typical of Kirisawa- type uveitis in funduscopic and fluorescein angiographic aspects. In both cases, the exudates appeared as granular deposits beneath the detached retina and were thought to be of choroidal origin.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(4) : 395-400, 1987