HIF-PH阻害薬投与後に糖尿病黄斑浮腫が増悪した1例

A case of diabetic macular edema exacerbated after administration of HIF-PH inhibitor

要約　目的：低酸素誘導因子プロリン水酸化酵素（HIF-PH）阻害薬の投与後に糖尿病黄斑浮腫が増悪した1例を経験したので報告する。

症例：61歳，女性。近医より，糖尿病網膜症または高血圧性網膜症の精査加療目的に当科を紹介され受診となった。

所見：初診時，斑状・しみ状出血散在，著明な硬性白斑を認め，光干渉断層撮影では黄斑近傍に浮腫を認めた。また，蛍光眼底造影検査では，後極に網膜細動脈瘤と蛍光漏出が多発し，無灌流領域も散在しており，糖尿病網膜症および糖尿病黄斑浮腫の診断となった。全身状態の改善に伴い糖尿病網膜症は改善傾向であり，網膜細動脈瘤に対する複数回の網膜光凝固術施行により，黄斑浮腫は中心窩には及ばず経過していた。しかし，初診から3年後，両眼黄斑浮腫の増悪を認めた。内科で腎性貧血の治療としてエリスロポエチン製剤からHIF-PH阻害薬に切り替えた後に黄斑浮腫の増悪を認めたため，HIF-PH阻害薬の関与が疑われ薬剤を中止したところ，黄斑浮腫は速やかに改善した。

結論：今回，HIF-PH阻害薬の投与後に糖尿病黄斑浮腫が増悪した貴重な1例を経験した。新薬の有害事象の検討に関しては，内科との連携が特に重要である。

Abstract　Purpose：To report a case of diabetic macular edema that exacerbated after the administration of a hypoxia-inducible factor prolyl hydroxylase（HIF-PH）inhibitor.

Case：The patient reported here was a 61-year-old woman with right vision loss. She was diagnosed with diabetic retinopathy or hypertensive retinopathy by a nearby ophthalmologist and referred to our hospital for detailed examination and treatment.

Findings：At first visit, the blot hemorrhages and hard exudates scattered in the fundus were observed, and optical coherence tomography revealed bilateral edema near the macula. Fluorescein angiography revealed scattered non-perfusion areas and many retinal microaneurysms and fluorescent leakages at the posterior pole of eyeball. The diabetic retinopathy resulted an improvement of her general condition and the macular edema did not extend to the fovea even after several direct photocoagulations. However, three years later, the bilateral macular edema exacerbated. Because exacerbation of macular edema was observed after switching from erythropoietin preparation to an HIF-PH inhibitor as a treatment for renal anemia, we suspected involvement of the HIF-PH inhibitor. Thus, the HIF-PH inhibitor was discontinued, and her macular edema improved rapidly.

Conclusion：We experienced a case, in which diabetic macular edema exacerbated after the administration of an HIF-PH inhibitor. Cooperation with internal medicine is especially important when examining adverse events of new drugs.