巨大結節性後部強膜炎の1例

A case of giant nodular posterior scleritis

要約　目的：強力な治療で軽快した巨大結節性後部強膜炎の1症例の報告。症例：48歳女性が両眼の強膜炎で紹介受診した。2か月前に両眼の虹彩炎と診断され，1か月後に両眼の強膜炎が発症した。ステロイド薬の局所と全身投与で改善がなかった。所見：矯正視力は右0.3，左0.8で，両眼に前房の強いフレアと硝子体混濁があり，上方の強膜に充血した結節があった。MRIで上方後部の強膜に強い肥厚があり，巨大結節性後部強膜炎と診断した。当初は治療に抵抗した。メチルプレドニゾロンなどの副腎皮質ステロイド薬の大量投与に，コルヒチンとメトトレキサートを加え，2か月後に病勢が鎮静化した。結論：巨大結節性後部強膜炎は眼内腫瘍に似た所見を呈することがある。本症例のような難治例では，強力な抗炎症薬と免疫抑制薬の全身と局所投与が奏効した。

Abstract.　Purpose：To report a case of giant nodular posterior scleritis that subsided after intensive medical treatment. Case：A 48-year-old female was referred to us for bilateral scleritis. She had been diagnosed with bilateral iritis 2 months before and with scleritis one month before. Treatment with topical and systemic corticosteroid was apparently ineffective. Findings：Corrected visual acuity was 0.3 right and 0.8 left. Both eyes showed intense aqueous flare, vitreous opacity, and hyperemic nodule in the upper scleral sector. Magnetic resonance imaging（MRI）showed intense thickness in posterior sclera in both eyes. The findings led to the diagnosis of giant nodular posterior scleritis. The condition resisted conventional treatment with corticosteroid. It subsided 2 months later after additional treatment with methotrexate and colchicine. Conclusion：The present case illustrates that giant nodular posterior scleritis may simulate intraocular tumor. Treatment with anti-inflammatory and immunosuppressive drugs was effective after conventional therapy had failed.