Human T-lymphotropic virus type I associated myelopathy （HAM）に合併した網膜血管炎

Retinal vasculitis associated with human Tlymphotropic virus type I myelopathy (HAM)

　ヒトレトロウイルスであるHTLV-Ⅰに関連した脊髄症はHTLV-Ⅰ　associated　myelopathy （HAM）と称され，現在556例の報告があるが，網膜血管炎を合併した症例の報告はない。今回，12症例のHAMの患者の眼科的検査を行い，5例に硝子体混濁を，そのうち3例に網膜血管炎を認めた。49，50，58歳の女性3症例とも，歩行障害，排尿障害，霧視を主訴とし，血液，髄液の抗HTLV—Ⅰ抗体は高値であった。病歴12年の症例では網膜周辺部の静脈は白鞘化し，眼底後極に血管炎を認めた。他の2例では網膜周辺部に静脈炎を認めた。2症例はステロイド剤の投与にかかわらず血管炎は持続した。他の1例ではインターフェロンの投与をおこない，血管炎は消失した。他の疾患からくる網膜血管炎の除外診断をおこなった。HTLV-Ⅰ罹患地域では，HAMに網膜血管炎が合併することを留意する必要がある。

Human T-lymphotropic virus type I (HTLV-Ⅰ) has recently be found to be associated with a chronic slowly progressive myelopathy. No instance of retinal vasculitis has been known in these patients. We evaluated 12 patients with HTLV-Ⅰ associated myelopathy (HAM).

We detected vitreous opacity in 5 patients, of which retinal vasculitis was present in 3. All the 3patients were females, aged 49, 50, 58 years respec-tively. We could rule out other diseases as causes for the retinal vasculitis. Retinal vasculitis was present bilaterally in 1 and unilaterally in 2 patients. Periphlebitis was the predominant feature of retinal vasculitis, appearing as sheathing of veins in the peripheral retina. Retinal hemorrhage, exudate or necrosis was consistently absent. Involvement of the anterior segment was minimal.

Systemic corticosteroid was beneficial for the neur-ological signs, but the retinal vasculitis persisted in 2 patients. One patient was treated with interferon to relieve myelopathy. Retinal vasculitis disappear-ed following the treatment.