PR3-ANCA陽性潰瘍性大腸炎に合併した汎ぶどう膜炎の1例

A case of panuveitis associated with PR3-ANCA positive ulcerative colitis

要約　目的：PR3-ANCA陽性潰瘍性大腸炎（UC）に合併した汎ぶどう膜炎の1例を報告する。

症例：患者は37歳女性。1年前から続く下痢で苦しんでいた。1か月前から右眼の充血と眼痛を自覚し受診した。

所見：矯正視力は右0.6，左1.0，眼圧正常，両眼前房に1＋の炎症細胞と微細な角膜後面沈着物を認めた。右眼には硝子体混濁に加え，眼底に黄斑浮腫が確認できた。フルオレセイン蛍光眼底造影検査で両眼にシダ状蛍光漏出を認め，網膜血管炎と診断した。血液検査でCRPの上昇に加え，PR3-ANCAの高値（49.4U/ml）を認めた。下部消化管内視鏡検査が施行され，UCと診断された。UCに合併した非肉芽腫性汎ぶどう膜炎と診断し，5-アミノサリチル酸製剤に加え，ステロイド点眼および内服による加療を行ったところ，前眼部炎症と黄斑浮腫は消失し，矯正視力も両眼1.5に改善した。

結論：PR3-ANCA高値を伴うUCでは，両眼性・非肉芽腫性の汎ぶどう膜炎を発症する可能性がある。

Abstract　Objective：To report a case of panuveitis associated with PR3-ANCA positive ulcerative colitis（UC）.

Case：A 37-year-old woman presented to our hospital with hyperemia and ocular pain on her right eye, and continuous diarrhea for one year.

Findings：The corrected visual acuity was 0.6 in the right eye and 1.0 in the left, and intraocular pressure was normal. Slit-lamp examination showed anterior chamber cells（Grade 1＋）and fine keratic precipitates. Funduscopy showed hazy vitreous and macular edema in the right eye. Fluorescein angiography revealed retinal vasculitis findings with fern-leaf pattern of capillary leakage in both eyes. A blood test showed elevated C-reactive protein levels and increased PR3-ANCA levels（49.4 U/ml）. Findings of UC were observed on lower gastrointestinal endoscopy. The patient was diagnosed with non-granulomatous panuveitis associated with UC. Steroid eye drops and oral prednisolone, in addition to 5-aminosalicylic acid, were administered. Consequently, inflammation of the anterior segment and macular edema disappeared, and the corrected visual acuity improved to 1.5 in both eyes.

Conclusion：UC patients with increased PR3-ANCA levels may develop non-granulomatous panuveitis.