佐賀大学における真菌性鼻性視神経症の検討

Review of fungal rhinogenous optic neuropathy at Saga University

要約　目的：佐賀大学医学部附属病院（当院）において最近経験した鼻性視神経症の症例の原因と経過について検討する。

対象と方法：2012年4月〜2019年3月に当院で真菌性鼻性視神経症に対して加療を行い，3か月以上経過観察できた4例を後ろ向きに検討した。3例が片眼性，1例が両眼性で，男性1例・女性3例，初診時平均年齢は71.0±16.0歳，平均経過観察期間は17.5±10.4か月であった。既往歴としてステロイド投与が3例，副鼻腔炎手術が1例にあった。

結果：初診時の矯正視力は0.03が1例，手動弁が1例，光覚なしが2例で，視力低下の自覚は2週間前〜3か月前であった。MRIで全例で鼻性視神経症が疑われたが，1例は明らかな骨破壊像はなかった。当院耳鼻咽喉科にて全例で内視鏡下副鼻腔手術を行い，いずれも切除病変の病理検査でアスペルギルス症と診断された。手術前後より抗真菌薬投与を行ったものの，最終視力は全例で光覚なしと不良であった。

結論：近年，免疫抑制薬や抗腫瘍薬の汎用に伴い，副鼻腔真菌症が増加傾向である。中枢神経系への浸潤は生命予後も不良となるため，眼痛を伴う著明な視力低下を認めた場合は，本症も念頭に早急な画像検査や耳鼻科診察が必要である。

Abstract　Purpose：To report 4 cases of fungal rhinogenous optic neuropathy at Saga University.

Cases and Method：We reviewed 4 cases who were diagnosed with fungal rhinogenous optic neuropathy in the past 7 years. They were followed up for 3 months or longer. The series comprised 3 males and 1 female. The age ranged from 51 to 84 years, average 71 years. Three cases were unilaterally and one case was bilaterally affected. Three cases had a history of systemic treatment with corticosteroid. One had received sinus surgery.

Findings and Clinical Course：Visual acuity of the affected eye at the initial visit was 0.06, 0.03, and hand motion in one eye each, and no light perception in 2 eyes. Visual impairment had been present since 2 to 12 weeks before. Magnetic resonance imaging（MRI）showed findings suggesting rhinogenous optic neuropathy. All the cases received sinus surgery and showed aspergillosis. Final visual acuity was no light perception in all the affected eyes.

Conclusion：The present cases seem to illustrate that mycosis of the paranasal sinus is on the increase in recent years, probably due to general use of immunosuppressants and antimalinancy agents. Final visual outcome was poor in all the eyes with optic neuropathy.