難治性の上眼瞼腫脹に対し皮膚生検にて肉芽腫性眼瞼炎と診断された1例

A case of granulomatous blepharitis with refractory eyelid edema diagnosed by skin biopsy

要約　目的：肉芽腫性眼瞼炎は，眼瞼の持続性腫脹と病理組織学的に類上皮細胞性肉芽腫を特徴とする疾患である。今回筆者らは，難治性の上眼瞼腫脹に対して皮膚生検にて肉芽腫性眼瞼炎と診断した1例を経験したので報告する。

症例：77歳，女性。皮膚弛緩症に対して上眼瞼皮膚切除術が施行された後，右上眼瞼腫脹が増悪し，改善しないため当科へ紹介となった。

所見：右上眼瞼より皮膚生検を施行し，病理検査で真皮内に浮腫と血管・付属器周囲にリンパ球主体の炎症細胞浸潤，類上皮細胞性肉芽腫を認めたため，肉芽腫性眼瞼炎と診断した。トラニラストの内服投与を行い，症状は軽快した。

結論：肉芽腫性眼瞼炎は本邦ではこれまで主に皮膚科から報告されている。難治性の眼瞼腫脹は鑑別疾患の1つとして本症を検討する必要があり，眼科医も留意すべき疾患と考えた。

Abstract　Background：Granulomatous blepharitis is characterized by persistent swelling of the eyelid and epithelioid cell granuloma pathologically.

Purpose：We report a case of granulomatous blepharitis with refractory upper eyelid swelling diagnosed by skin biopsy.

Case：The patient was a 77-year-old woman. After an upper eyelid skin resection for blepharochalasis, the right upper eyelid swelling worsened and did not improve；subsequently the patient was referred to our hospital.

Findings：Skin biopsy was performed on a sample resected from the right upper eyelid；pathological examination showed edema, inflammatory cell infiltration with lymphocytes around blood vessels and appendages, and epithelioid cell granuloma in the dermis. We diagnosed granulomatous blepharitis. The patient was treated with oral tranilast, and her symptoms improved.

Conclusion：In Japan, granulomatous blepharitis has been mainly reported by dermatologists. This disease should be considered as one of the differential diagnosis for refractory eyelid swelling, and ophthalmologists should pay attention to it.