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要約 目的:抗アクアポリン4抗体陽性視神経炎に免疫グロブリン静注が奏効した症例の報告。症例:42歳女性が6日前からの左眼霧視で受診した。所見と経過:矯正視力は左右眼とも1.2で,求心性の視野狭窄があった。左眼の球後視神経炎が疑われた。41日後に左眼視力が0.03に低下し,ステロイドのパルス療法で改善しなかった。その後,抗アクアポリン4抗体陽性であることが判明し,視神経脊髄炎と関連した視神経炎と診断した。全血漿交換療法で視力は0.8に改善した。初診5か月後に左視神経炎が再発し,全血漿交換療法が奏効した。初診8か月後にさらに再発し,大量免疫グロブリン静注を5日間行い,以後7か月後の現在まで再発はない。結論:再発を繰り返す抗アクアポリン4抗体陽性視神経炎に,大量免疫グロブリン静注が有効であった。
Abstract. Purpose:To report a case of anti-aquaporin 4 antibody-positive optic neuritis that subsided after intravenous injection of immunoglobulin. Case:A 42-year-old woman presented with blurring of vision in the left eye since 6 days before. Findings:Corrected visual acuity was 1.2 in either eye. Concentric narrowing of visual field was present. The findings were suggestive of retrobulbar optic neuritis in the left eye. Left visual acuity decreased to 0.03 41 days later. Pulsed corticosteroid therapy was ineffective. She proved positive for anti-aquaporin 4 antibody and was diagnosed as optic neuritis related to opticomyelitis. Visual acuity improved to 0.8 after plasma exchange therapy. Recurrence 5 months after initial visit was effectively treated by the same therapy. Recurrence 8 months after initial visit was suppressed after intravenous injection of massive immunoglobulin. She has been doing well for 7 months until present. Conclusion:Intravenous immunoglobulin was effective for recurrent anti-aquaporin 4 antibody-positive optic neuritis.
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