劇症型の猫ひっかき病の1例

A case of fulminant cat scratch disease

要約　目的：劇症型の猫ひっかき病の1例の報告。

症例：51歳の男性が数週間前からの右眼の視力低下で受診した。矯正視力は右0.7，左1.2で，右眼の眼底に乳頭の発赤と浮腫があり，光干渉断層計で乳頭から黄斑にかけての網膜剝離があった。4日後に乳頭浮腫と黄斑部の網膜剝離が増悪した。問診で，2か月前に野良猫に引っ搔かれたことと，2週間前に子猫のノミに咬まれたことが判明した。手と前腕部に水疱があり，38.5℃の発熱があった。初診の1週間後に右眼視力は0.03になり，20日後にBartonella IgGとIgM抗体が上昇していることが判明した。猫ひっかき病と診断し，テトラサイクリンの内服を開始した。黄斑部の萎縮が生じ，視力は0.2にとどまった。

結論：猫ひっかき病は自然治癒の傾向があり，視力予後が良好とされているが，本症例は劇症型で視力障害が残った。

Abstract　Purpose: To report a case with ocular involvement of fulminant cat scratch disease.

Case: A 51-year-old man presented with impaired vision in the right eye since a few weeks before.

Findings: Corrected visual acuity was 0.7 right and 1.2 left. The right eye showed hyperemia and swelling of optic disc. Optical coherence tomography（OCT）showed serous retinal detachment in the macula. Fundus findings exacerbated with right visual acuity of 0.03. After further inquiry, he had been scratched by a roaming cat 2 months before and been infested by cat lice 2 weeks before. Three weeks after his initial visit, laboratory tests showed elevated titers of IgM and IgG antibodies to Bartonella henselae. He was diagnosed with diagnosis of cat scratch disease and started receiving peroral tetracycline. Visual acuity remained at 0.2 due to macular atrophy.

Conclusion: Cat scratch disease has been regarded as benign regarding ocular involvement. This case illustrates that lasting visual defect may remain fundus lesion is fulminant.