シクロスポリン併用が有効であったステロイド抵抗性のVogt-小柳-原田病

Combined treatment with systemic cyclosporine and corticosteroid was effective in four cases of corticosteroid-resistant Vogt-Koyanagi-Harada disease

要約　目的：複数回のステロイドパルス療法により，消炎しないか，ステロイドの内服漸減中に再燃するステロイド依存性のVogt-小柳-原田病（原田病）に，シクロスポリンの併用が奏効した4症例の報告。

症例：症例は原田病と診断した男性3例と女性1例で，年齢はそれぞれ43，49，57，73歳である。全例にステロイドパルス療法を行い，1例は3クールで消炎し，1例は消炎せず，2例は再燃の徴候を呈した。シクロスポリンの併用により消炎したが，うち1例は腎障害のため減量後に再燃があり，ステロイドを増量した。

結論：ステロイドに抵抗または依存する原田病4例に対し，シクロスポリンを併用することで，消炎またはステロイドの減量と中止ができた。

Abstract　Purpose：To report 4 cases of Vogt-Koyanagi-Harada（VKH）disease who showed resistance or recurrence of the disease and who were brought under control by combined treatment of systemic cyclosporine and corticosteroid.

Cases：The series comprised 3 males and one female. They were aged 43, 49, 57 and 73 years respectively. All the cases were initially treated by pulsed corticosteroid therapy. One case resolved after 3 courses of pulsed corticosteroid. One case failed to resolve. Two cases showed signs of recurrence. All the 4 cases resolved after additional cyclosporine. One of the 4 cases showed recurrence after tapering of cyclospsorine due to renal problems. Ocular findings were brought under control by increased dosage of corticosteroid.

Conclusion：Ocular manifestations in 4 cases of VKH disease, that showed resistance to or dependence on corticosteroid, resolved after combined use of cyclosporine and corticosteroid.