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要約 目的:急性網膜壊死(ARN)は稀に再発することが知られている。今回二度の再発がみられた単純ヘルペスウイルス(HSV)によるARNの1例を経験したので報告する。
症例と所見:12歳,女性。右眼に前房炎症,硝子体混濁,全周の網膜血管の白鞘化,白色滲出斑の散在がみられた。点眼治療のみで網膜瘢痕病巣を残して治癒した。22歳時に再発した。右眼に強い前房炎症,硝子体混濁がみられ,眼底は透見困難であり,前房水のPCR検査にてHSVが検出され,HSVによるARNが疑われた。アシクロビル(ACV)点滴とプレドニゾロン(PSL)内服にて硝子体混濁が薄くなるとともに網膜動脈白鞘化を伴う網膜白色病変がみられ,その後,網膜瘢痕病巣を残して治癒した。31歳時に再発した。右眼に前房炎症,硝子体混濁,網膜血管白鞘化,耳側網膜に白色病変がみられた。前房水のPCR検査にてHSV-2が検出され,HSV-2によるARNと診断。ACV持続静注とPSL内服を開始し,網膜白色病変は徐々に消退したが,硝子体混濁の増悪がみられたため硝子体手術を施行した。術後2年が経過し,網膜剝離に至ることなく経過している。
結論:HSVによるARNは長期間の潜伏期間を経て再発することがあり,軽快後も慎重に経過観察する必要がある。
Abstract Purpose:Acute retinal necrosis(ARN)can occasionally recur. Herein, we report a case of herpes simplex virus(HSV)-2 ARN with presumed multiple recurrences.
Case:A 12-year-old girl presenting with redness and blurred vision in the right eye(OD)was referred to our hospital.
Findings:Uveitis with vitreous opacity, retinal vessel sheathing, and yellow-white retinal lesions in her peripheral retina OD were noted. Although she was treated with eye drops in her right eye, retinal scars remained. At the age of 22, she visited our hospital with the ocular pain and blurred vision in her right eye. Due to severe anterior chamber inflammation and vitreous opacity, ocular fundus could not be seen OD. HSV DNA was detected by polymerase chain reaction(PCR)testing of a sample of aqueous humor, and HSV ARN was suspected. Treatment with intravenous acyclovir and oral prednisolone resolved vitreous opacity but retinal scarring remained. At the age of 31, she visited our hospital with ocular pain and redness OD. Anterior chamber inflammation, vitreous opacity, retinal vessel sheathing and widespread yellow-white retinal lesions at the temporal periphery OD were observed. The detection of HSV-2 by PCR examination with aqueous humor led to a definite diagnosis of HSV-2 ARN OD. Treatment with intravenous acyclovir and oral prednisolone led to gradual resolution of retinal lesions;however, vitreous opacity worsened and vitrectomy was performed. Since the surgery, the patient has maintained acceptable visual function without retinal detachment after 2 years.
Conclusion:Since HSV ARN may recur after an interval of several years, periodic follow-up should continue after remission.
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