ぶどう膜・視神経・強膜に炎症を生じた神経梅毒の1例

A case of neurosyphilis associated with inflammation in the uvea, optic nerve, and sclera

要約　目的：ぶどう膜・視神経・強膜に炎症を生じた神経梅毒の1例を報告する。

症例：74歳，男性。2年前に左眼うっ血乳頭を指摘され，他院脳神経外科で異常なしと診断された。1年前に左眼充血を主訴に近医眼科を受診し，抗菌薬とステロイド点眼で改善がないまま経過観察された。1か月前に左視力低下をきたし当科に紹介された。

所見：視力は右（1.2），左（0.4）。左眼の球結膜充血があり，乳頭は境界不鮮明で，軽度の硝子体混濁と光干渉断層撮影で黄斑浮腫，網膜下液を認めた。限界フリッカ値は右43Hz，左25Hz。フルオレセイン蛍光眼底造影の後期相に左眼のleakageによる過蛍光斑が眼底全体に広がり，特に乳頭周囲に密集していた。インドシアニングリーン蛍光眼底造影では，左眼に限局性の低蛍光斑が複数箇所にみられた。血液および髄液の梅毒血清反応，梅毒トレポネーマ蛍光抗体吸収検査がともに高値で神経梅毒と診断した。ベンジルペニシリン全身投与後も黄斑浮腫が軽減しないため，初診1か月および6か月後にトリアムシノロンアセトニドテノン囊下注射を施行した。充血と黄斑浮腫は軽快し，左視力は（0.8）に改善した。

結論：本例はぶどう膜，視神経炎，強膜炎を合併した神経梅毒である。駆梅治療のみでは眼所見は完全には改善せず，ステロイドテノン囊下投与が奏効した。

Abstract　Purpose：A case of syphilis associated with inflammation in uvea, optic nerve, and sclera was presented.

Case：A case was a 74-year-old male who had papilledema in the left eye two years before. He received neurological examination that found no abnormality. He has received antibacterial and steroid eye drops for the injection of his left eye since one year ago. He was referred to our department presenting with the one-month visual deterioration of his left eye.

Findings：His visual acuity was 1.2 OD and 0.4 OS. He had scleritis, papilledema, mild vitritis in the left eye. Macular edema and subretinal fluid were observed by OCT. CFF was 43 Hz OD and 25 Hz OS. Fluorescein angiography showed hyperfluorescent plaques in the whole retina especially gathering around the optic disc. Indocyanine green angiography showed local hypofluorescent areas in the choroid. Both serologic test for syphilis and Treponema pallidum hemagglutination were positive in blood and cerebrospinal fluid. He received a systemic administration of benzylpenicillin for the treatment of syphilis, however, macular edema was not resolved. Sub-tenon's triamcinolone acetonide injections were performed twice at one and six months after. Inflammation in the sclera and macular edema were resolved and his visual acuity improved to 0.8 OS.

Conclusions：This was a case of neurosyphilis complicated with uvetis, optic neuritis, and scleritis. Antiluetic therapy had little effects to macular edema but triamcinolone acetonide injections were effective.