角膜浮腫のため診断に難渋した若年性黄色肉芽腫による小児続発緑内障の1例

Diagnostic difficulties in a case of glaucoma secondary to juvenile xanthogranuloma with marked corneal edema

要約　目的：角膜の混濁が強く，前房と隅角の観察が十分に行えず，初診時の診断に難渋した若年性黄色肉芽腫の症例の報告。

症例：生後8か月の女児が左眼の結膜充血と角膜混濁で紹介受診した。右眼は隅角の所見を含め，眼科的に正常であった。左眼は角膜の浮腫と混濁が強く，詳細な観察が困難であった。小児緑内障の疑いで，複数の眼圧下降薬を点眼し，角膜浮腫は軽快した。2週間後の再診時に前房出血と前房内の炎症所見があり，続発緑内障の可能性を考えたが，眼内に腫瘍性病変はなかった。同時期に背部に皮疹が生じ，生検で若年性黄色肉芽腫と診断され，これに続発した緑内障と判断した。

結論：角膜の混濁が強く，診断に苦慮した乳児の緑内障が，若年性黄色肉芽腫に続発して生じたことが判明した。

Abstract　Purpose: To report a case of glaucoma secondary to juvenile xanthogranuloma who showed difficulties in the diagnosis due to marked corneal edema.

Case: An 8-month-old female baby presented with conjunctival hyperemia and corneal opacity. The right eye was found normal. The left eye showed marked corneal edema that prevented detailed examination of the chamber angle and the anterior chamber. She was tentatively diagnosed as infantile glaucoma and was treated by topical antiglaucoma medications. The cornea became transparent 2 weeks later. The left eye showed hyphema and findings of inflammation in the anterior chamber. The findings were suggestive of secondary glaucoma but no intraocular tumor was present in the left eye. She then showed papules in the back. Biopsy led to the diagnosis of juvenile xanthogranuloma with secondary glaucoma.

Conclusion: The present case of infantile glaucoma proved to be secondary to juvenile xanthogranuloma.