両側肺門リンパ節腫脹（BHL）よりサルコイドーシスが疑われ，脳生検にて悪性リンパ腫の診断に至った1症例

Malignant lymphoma diagnosed by brain biopsy in a case initially suspected of sarcoidosis due to bilateral hilar lymphadenopathy

要約　目的：ぶどう膜炎と両側肺門リンパ節腫脹（BHL），肺野病変，多発性脳病変からサルコイドーシス（サ症）が疑われた中枢神経原発悪性リンパ腫の1例。症例：69歳，男性。右前房内細胞と両びまん性硝子体混濁がみられ，BHLと縦隔リンパ節腫大，肺野病変よりサ症が疑われた。頭部MRIにて多発性脳病変がみられ，認知症状の進行により悪性リンパ腫が疑われた。経気管支肺生検では両者の鑑別はつかず，脳生検を施行し，中枢神経原発悪性リンパ腫と診断された。メトトレキサート大量療法により脳病変，眼病変ともに改善した。結論：ぶどう膜炎に肺門・縦隔のリンパ節腫脹，脳病変がみられた場合は，サ症と悪性リンパ腫を早急に鑑別する必要がある。

Abstract.　Purpose：To report a case who was initially suspected of sarcoidosis due to bilateral hilar lymphadenopathy and who was finally diagnosed with malignant lymphoma by brain biopsy. Case：A 69-year-old male presented with bilateral blurring of vision left. Corrected visual acuity was 0.7 right and 0.6 left. The right eye showed signs of anterior uveitis. Both eyes showed vitreous opacity. Computed tomography showed bilateral hilar lymphadenopathy and swelling of lymphnodes in the mediastinum. The findings were suggestive of sarcoidosis. Magnetic resonance imaging showed intracranial lesions 3 months later. Brain biopsy led to the diagnosis of diffuse large B-cell lymphoma. Treatment with massive dosis of methotrexate was followed by improved brain and ocular lesions for 5 months until present. Conclusion：The present case illustrates that malignant lymphoma may manifest symptoms simulating ocular sarcoidosis.