エルロチニブ内服が誘因と考えられる網膜症の1症例

Bilateral retinopathy in a case under treatment with peroral erlotinib

要約　背景：エルロチニブは，細胞の表面に発現する上皮成長因子受容体を選択的に阻害する内服抗癌剤である。

目的：肺腺癌に対するエルロチニブの内服中に網膜症が生じた1例の報告。

症例：64歳男性が両眼のかすみで受診した。4年前に肺腺癌で手術を受け，その1年後に脳転移が生じ，4日に1回のエルロチニブ150mgの内服を開始した。

所見と経過：矯正視力は右1.0，左1.2で，両眼の眼底に多数の硬性白斑と網膜出血があり，右眼に網膜浮腫と漿液性剝離があった。その所見は糖尿病網膜症に類似していた。エルロチニブを7日に1回へ減量し，右眼の網膜剝離は消失した。1年後に左眼に漿液性網膜剝離が生じた。エルロチニブの内服を中止し，3か月後に網膜剝離は消失した。

結論：エルロチニブの内服で糖尿病網膜症に類似する網膜症が発症した可能性がある。

Abstract　Purpose: To report a case who showed bilateral retinopathy following peroral treatment with erlotinib.

Case: A 64-year-old male presented with blurring of vision in both eyes. He had received surgery for adenocarcinoma of the lung 4 years before. Metastasis to the brain had developed one year later and he started treatment with peroral erlotinib at the dosis of 150 mg every 4 days.

Findings and Clinical Course: Corrected visual acuity was 1.0 right and 1.2 left. Both eyes showed numerous hard exudates and retinal hemorrhagic patches. The right eye showed retinal edema and serous retinal detachment. The findings simulated diabetic retinopathy. Serous retinal detachment disappeared after reduction of erlotinib every 7 days. The left eye developed serous retinal detachment one year later. Discontinuation of erlotinib was followed by disappearance of serous retinal detachment 3 months later. He has been doing well for 12 months until present.

Conclusion: Peroral erlotinib may have induced retinopathy in the present case.