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要約 目的:ヒトT細胞白血病ウイルスに関連する疾患として,成人T細胞白血病(ATL)がある。ATLの眼内浸潤により硝子体混濁が生じた1例を報告する。
症例:52歳,男性。1か月前からの両眼の飛蚊症と硝子体混濁で紹介され受診した。2年前にATLと診断され,同種造血幹細胞移植で寛解し,血液内科で加療中であった。
所見と経過:矯正視力は両眼とも1.2で,両眼に軽度の硝子体混濁が下方にあった。診断と治療の目的で,右眼に硝子体手術を行った。病理学的検査で花弁状細胞があり,ATLの眼内浸潤と診断した。6か月後の最終受診時に,右眼の硝子体混濁の再燃はなく,左眼に所見の悪化はなかった。視力は両眼とも1.2であった。
結論:ATLの眼内浸潤は稀で,ぶどう膜炎,日和見感染などとの鑑別が必要である。本症例では硝子体切除でATLの眼内浸潤の診断が確定し,良好な転帰が得られた。
Abstract Purpose:To report a case of adult T-cell leukemia(ATL)who showed vitreous opacity due to intraocular infiltration of leukemic cells.
Case:A 52-year-old male was referred to us for seeing floaters and vitreous opacity in both eyes since one month before. He had been diagnosed with ATL two years ago that resolved following transplantation of allogeneic hematopoietic stem cells.
Findings and Clinical Course:Corrected visual acuity was 1.2 in either eye. Both eyes showed mild vitreous opacity in the inferior sector. The right eye received vitrectomy for diagnosis and treatment. Pathological studies showed flower petal cells, leading to the diagnosis of intraocular infiltration of ATL cells. At the latest follow-up 6 months later, the right eye showed resolution of vitreous opacity. The left eye showed no change in the vitreous. Visual acuity was 1.2 in either eye.
Conclusion:Intraocular infiltration of ATL cells is rare and has to be differentiated from uveitis and opportunistic infection. In the present case, vitrectomy led to the diagnosis of intraocular infiltration of ATL cells and resulted in fair clinical outcome.
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