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要約 目的:眼症状を契機に確定診断された梅毒性ぶどう膜炎6例の臨床像について報告する。
対象と方法:2018年11月〜2022年4月に原因不明のぶどう膜炎で獨協医科大学病院を受診し,梅毒性ぶどう膜炎と診断された症例6例9眼(男性2例,女性4例,平均年齢55.0±5.6歳)に対し,臨床所見および治療経過について後ろ向きに調査した。
結果:すべての症例が2期梅毒以上の確定診断を受けた。髄液検査を施行した5例中3例で髄液細胞増多を認めたが,神経学的所見は1例で認めるのみであった。駆梅療法は確定診断後の未受診患者1例を除いた5例全例で施行され,矯正視力の改善またはlogMAR視力−0.1の維持を認めた。
結論:当院で眼症状を契機に梅毒感染が明らかとなった症例では,神経梅毒が多く認められた。原因不明のぶどう膜炎の精査時には梅毒性ぶどう膜炎も念頭に置き,他科と連携した全身精査が重要と考えられる。
Abstract Purpose:To discuss the clinical manifestations and courses of 6 syphilitic uveitis in six cases diagnosed at our institution which initially manifested with ocular symptoms.
Methods:Six patient who presented to out institution between November 2018 to April 2022 with unexplained uveitis and were diagnosed with syphilitic uveitis were retrospectively studied. Nine eyes of two men and four women(age, 55±5.6 years)were analysed.
Results:All patients were diagnosed with secondary or tertiary syphilis. Cerebrospinal fluid was examined in five cases, with positive results in three(60%). Of the three cases, neurological symptoms were observed in one. We administrated antiluetic therapy to five patients, all of whom experienced improvement in visual acuity, which was maintained at logMAR −0.1. One patient refused treatment and remained untreated.
Conclusion:Neurosyphilis was observed in most of our patients diagnosed with syphilitic uveitis. It is important to assess syphilitic uveitis when evaluating uveitis with unexplained origin, and to provide multidisciplinary care upon diagnosis.
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