ステロイドパルス療法が奏効した側頭動脈炎の1症例

Pulsed corticosteroid therapy was effective in a case with temporal arteritis

　メチルプレドニゾロン大量投与によるパルス療法が著効を示した側頭動脈炎の1例を報告した。症例は60歳男性で，右眼視力低下と眼痛，前頭部痛を主訴として来院した。右眼視力は指数弁（矯正不能）で，高度視野狭窄をみとめ，全身的には赤沈，CRP高値などがみられた。入院後右側頭部に腫脹，圧痛がみとめられたため，側頭動脈炎と臨床的に診断した。左眼にも視力低下を生じたため，メチルプレドニゾロンのパルス療法を行った。パルス療法後に行った生検では，巨細胞性動脈炎の所見は得られなかった。

　パルス療法後両眼の視力および視野は著明に改善し，重篤な副作用もみとめなかった。血管組織の炎症を軽減して虚血状態を早期に改善し，不可逆的変化を最少限にとどめるという意味で，パルス療法は有用であると考えた。

A 60-year-old male presented with right visual acuity reduced to finger counting. He had suffered from frontal headache, pain and photophobia in the right eye, and transient diplopia since 2 weeks before. Visual acuity started to fail in the right eye since 5 days before. Ophthalmological findings were unconspicuous except the presence of Marcus -Gunn's pupil in the right eye. Mild fever was present with erythrocyte sedimentation rate in-creased to 124 mm per hour. After 10 days treat-ment with 2 mg dexamethasone injected into the Tenon's capsule, the visual acuity decreased to no light perception in the right eye and to 0.04 in the left. Swelling and tenderness of right temporal arteries became obvious. We started treatment with intravenous metylprednisolone, 500 mg the first day, 1,000 mg for the next 3 days, and oral prednisolone 100 mg daily thereafter. On the 10th day of the treatment, the visual acuity improved to 0.8 in the right and 1.2 in the left.

The treatment was free of notable side effects. After tapering and eventual withdrawal of pred-nisolone, the patient obtained final visual acuity of 1.2 each with paracentral scotoma in the right eye.