重症アトピー性皮膚炎患者に発症した結膜扁平上皮癌の1症例

Squamous cell carcinoma of conjunctiva in a case of severe atopic dermatitis

要約　目的：アトピー性角結膜炎に対してタクロリムスを点眼中に増悪した結膜扁平上皮癌の1例の報告。症例：52歳男性が右眼の角膜ヘルペスの疑いで紹介受診した。重症のアトピー性皮膚炎があった。3年前に右眼に白内障手術を受けた。所見：アトピー性角結膜炎を疑う所見が右眼にあった。0.1％タクロリムス点眼で18か月後に角膜びらんが軽快した。さらに6か月後に球結膜の肥厚と色素沈着が生じ，生検で扁平上皮癌と診断された。IFNα-2bの点眼で寛解した。結論：重篤なアトピー性角結膜炎が，結膜扁平上皮癌の危険因子である可能性がある。タクロリムス点眼による腫瘍の発症または進展については不明である。

Abstract.　Purpose：To report a case of severe atopic dermatitis who developed squamous cell carcinoma of the conjunctiva after prolonged instillation of tacrolimus. Case：A 34-year-old male was referred to us for suspected herpetic keratitis in the right eye. He had had severe atopic dermatitis. He had received cataract surgery in the right eye 3 years before. Findings：The right eye showed signs suggestive of atopic keratoconjunctivitis. The corneal lesion resolved following 18 months of instillation of 0.1％ tacrolimus. Another 6 months later, the conjunctiva adjacent to cornea showed pigmentation and thickening. Biopsy led to the diagnosis of squamous cell carcinoma. The lesion resolved following instillation of IFNα-2b. Conclusion：Severe atopic keratoconjunctivitis may be a risk factor for squamous cell carcinoma of conjunctiva. Role of topical tacrolimus in its etiology needs further study.