Behçet病に合併した壊死性強膜炎の1例

Necrotizing scleritis in a case of Behçet disease

要約　目的：Behçet病に併発した壊死性強膜炎の1例の報告。

症例：40歳女性が2日前からの右眼瞼の蜂窩識炎の疑いで紹介受診した。8年前に口腔内アフタ，結節性紅斑，関節炎，虹彩炎，陰部潰瘍が発症し，完全型Behçet病と診断されていた。

所見と経過：矯正視力は左右眼とも1.5で，右眼にびまん性強膜充血があり，耳側球結膜に黄白色の結節があり，右眼瞼の発赤腫脹があった。造影CTで増強効果があり，壊死性強膜炎と診断した。眼瞼と頬部に感染が併発していた。抗菌薬，プレドニゾロン，シクロスポリンの全身投与で，翌日に改善傾向があり，14日後にほぼ軽快した。1年後の現在まで再発はない。

結論：8年前に発症したBehçet病の症例の片眼に生じた壊死性強膜炎に対し，シクロスポリンなどの全身投与で早期の寛解が得られた。

Abstract　Purpose: To report necrotizing scleritis in a case of Behçet disease.

Case: A 40-year-old woman was referred to us for suspected phlegmon in the right eye since 2 days before. She had been diagnosed with Behçet disease 8 years before after developing aphtha, nodular erythema, arthritis, irits and genital ulcer.

Findings and Clinical Course: Corrected visual acuity was 1.5 in either eye. The right eye showed diffuse hyperemia of subconjunctival tissue, nodules in the temporal sector of bulbar conjunctiva, and swollen eyelid. The anterior sclera showed enhanced image by angiographic computed tomography（CT）. The right eye was diagnosed with necrotizing scleritis. Infection also involved the eyelid and cheek. She was treated by systemic prednisolone, antibiotics, and cyclosporine. The ocular lesion started to improve the following day and was virtually cured after 2 weeks. There has been no recurrence for one year until present.

Conclusion: Systemic treatment with cyclosporine was effective for necrotizing scleritis in a case of Behçet disease.