アルベンダゾールとステロイドが著効した眼トキソカラ症の1例

A case of ocular toxocariasis effective with albendazole and oral steroid therapy

要約　目的：アルベンタゾールおよびステロイドが著効した眼トキソカラ症の1例を報告する。

症例：34歳，男性。1か月前からの右眼視野欠損を主訴に近医を受診した。右眼に硝子体混濁，漿液性網膜剝離，下方アーケード血管の網膜下に1.3乳頭径大の白色隆起認め，帝京大学医学部附属病院に紹介され受診した。当院受診時の矯正視力は右0.7。白色隆起から中心窩に向かって漿液性網膜剝離を認め，フルオレセイン蛍光眼底造影検査では早期から病変部からの蛍光漏出および組織染，加えて広範に静脈血管壁の過蛍光を認めた。血液検査では，CRP軽度上昇およびIgE高値を認めたが，好酸球増多は認めなかった。ウェスタンブロッティング試験にて眼トキソカラ症と診断した。診断後，アルベンダゾールおよびステロイド内服を開始した。白色隆起病変は線維化し，滲出性変化が改善した。右眼視力は治療開始2か月後には矯正視力1.0と改善した。

結論：アルベンダゾールおよびステロイド内服治療が著効した眼トキソカラ症を経験した。

Abstract　Purpose：Ocular toxocariasis is a disorder caused by intraocular larval migrans of Toxocara canis or T. cati. We report a case of ocular toxocariasis that was responded well to albendazole and oral steroid therapy.

Case：A-34-year-old male patient visited a local doctor with a complaint of a visual field defect of the right eye for one month. Vitreous opacity, serious retinal detachment, and white elevated legion 1.3 papillary diameters in size below the arcade vessels were observed on the right fundus. Visual acuity in the right eye was 0.7. A serous retinal detachment was observed extending from the white elevated lesion to the fovea. The leakage from the elevated lesion was observed at an early stage with the fundus fluorescein angiography. Tissue staining and hyperfluorescence of the extensive venous vessel wall were also observed. Blood tests showed mildly elevated C-reactive protein, elevated immunoglobulin E, but no eosinophils. Ocular toxocariasis was diagnosed by western blotting. Combined oral treatment with albendazole and prednisone was initiated after diagnosis. After treatment, the white elevated lesion in the fundus became fibrotic, and the exudative changes improved. Visual acuity in the right eye had improved to 1.0, two months after the start of treatment.

Conclusion：The patient responded well to albendazole and oral steroid therapy.