漿液性網膜剝離を呈した肥厚性硬膜炎の1例

A case of hypertrophic pachymeningitis with serous retinal detachment

要約　目的：関節リウマチに，強膜炎による漿液性網膜剝離と肥厚性硬膜炎による視神経症を合併した症例の報告。

症例：82歳女性が左眼の視力低下，充血を主訴に受診した。40年来の関節リウマチがあり，初診時の左眼視力は（0.1），上強膜血管の拡張，漿液性網膜剝離を認め，ガドリニウム造影MRIで強膜肥厚に加えて，前頭部を中心に硬膜の肥厚と増強効果を認めた。強膜炎，肥厚性硬膜炎の診断にて副腎皮質ステロイドのパルス療法を行い，症状は改善し，視力は（1.0）まで回復した。

結論：本症例は関節リウマチに強膜炎，肥厚性硬膜炎を同時に合併したと推察され，診断にはガドリニウム造影MRIが有用であった。

Abstract　Purpose：To report a case of scleritis-related serous retinal detachment and optic neuropathy with hypertrophic pachymeningitis.

Case：An 82-year-old woman presented with impaired visual acuity and hyperemia. She had had rheumatoid arthritis for 40 years. Her corrected visual acuity was 0.1 in the left eye. Her left eye showed scleral hyperemia and serous retinal detachment. Gadolinium-enhanced magnetic resonance imaging（MRI）of the brain revealed scleral thickening and meningeal thickening in the frontal lobe, leading to the diagnosis of scleritis and hypertrophic pachymeningitis. Pulsed corticosteroid therapy resulted in improved clinical ocular manifestation. Her visual activity improved to 1.0 five months later.

Conclusion：Enhanced MRI was useful in the diagnosis of scleritis and hypertrophic pachymeningitis at the same time.