サイトメガロウイルスによる網膜炎の1例

A case of cytomegalovirus retinitis

　64歳男性に認められたサイトメガロウイルス性網膜炎（以下CMV性網膜炎と略す）の1例について報告した．症例は経中心静脈栄養中，カンジダ菌血症を発症した．経過中両眼底には，後極部に多発性の網膜白色混濁およびロート斑を認めた．白色混濁病巣は硝子体中へ進行し，内因性カンジダ眼内炎を強く疑っていた．死後，病理組織学的および免疫組織学的に検索したところ，CMV性網膜炎であることが確認された．免疫螢光抗体法により，他のherpes virus群やカンジダによる混合感染は否定的であった．臨床的に内因性カンジダ眼内炎が疑われる症例には，CMVの混合感染，あるいはCMV性網膜炎を鑑別診断として念頭におく必要があると思われた．

A 64-year-old male was brought to the emer-gency room due to unconsciousness. He was dian-gosed as septicemia and was treated by massive systemic antibiotics. Systemic corticosteroid ther-apy was started 6 days later to treat asthmatous attacks. Intravenous hyperalimentation was also instituted. On day 20 of the disease, blood culture showed Candida albicans. The patient was referred to us on day 25.

Funduscopy showed multiple yellowish-white lesions and Roth spots in both fundi. The yellowish-white lesions were elevated. These findings were suggestive of candida endophthalmitis. The patient died on day 82 due to pneumonia.

Postmortem studies of the right eye revealed cytomegalovirus retinitis by light and electron microscopy and by immunofluorescent antibody test. Immunofluorescent antibody tests were nega-tive for antigens of Candida albicans, herpes sim-plex virus and herpes zoster viruses. Cytomegalovir-us retinitis is a possibility in presumed candida endophthalmitis.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(6) : 703-707, 1987