眼梅毒5症例の臨床像について

Clinical features of five cases of ocular syphilis

要約　目的：筆者らが最近経験した眼梅毒5症例を報告する。

対象と方法：対象は5症例8眼。レトロスペクティブスタディ。

結果：全例35〜50歳の男性であり，梅毒第2期であった。2例は男性間性交渉者，3例はHIV感染を合併していた。髄液検査を行った3例すべてに神経梅毒があった。両眼性（3例），汎ぶどう膜炎（4眼）が最も多かった。所見別には虹彩毛様体炎（7眼）が最も多く，次いで視神経乳頭腫脹（6眼），硝子体混濁（5眼）が多かった。全例に駆梅を行い予後はおおむね良好であったが，黄斑萎縮を残した症例が2例あった。

結論：眼梅毒所見は多彩であり，ぶどう膜炎や視神経乳頭炎の鑑別には梅毒を念頭に置く必要がある。

Abstract　Purpose：To present a review of 5 cases of ocular syphilis.

Cases：This retrospective study was made on consecutive 5 cases who were diagnosed with ocular syphilis in the past 8 years. Cases were excluded who had congenital syphilis or who had been diagnosed with syphilis before. They were followed up for 6 months to 8 years.

Findings：All the 5 cases were males and were aged from 35 to 50 years. Two cases were unilaterally and 3 cases were bilaterally affected. Panuveitis was present in 4 eyes, anterior uveitis in 3 eyes, and optic neuropapillitis in 6 eyes. All the 5 cases had stage 2 syphilis. Three cases were positive for human immunodeficiency virus（HIV）, of whom two were homosexuals. Cerebrospinal fluid was examined in 3 cases. All were positive and were diagnosed with neurosyphilis. All the 5 cases in the present series were treated by peroral amoxicillin, azithromycin, or intravenous benzylpenicillin. Ocular findings improved in all the cases with no recurrence during the follow-up period. Two eyes resulted in macular atrophy.

Conclusion：The present series illustrate that ocular syphilis may manifest diverse clinical features including uveitis. Syphilis is to be suspected in cases of uveitis or neuropapillitis.