初発から16年後にSAPHO症候群と診断された再燃を繰り返した上強膜炎の1例

A case of episcleritis diagnosed with SAPHO syndrome 16 years after the onset

要約　目的：上強膜炎の初発から16年後にSAPHO症候群と診断された1例の報告。

症例：51歳，女性。主訴は右眼の眼痛，充血。既往歴は慢性扁桃炎，結節性紅斑，掌蹠膿疱症などであった。左眼前眼部および両眼内に異常はなく，右眼上強膜炎の診断にてステロイドの点眼と内服で治癒した。10年後に再び右眼上強膜炎で当科を受診し，これ以降に上強膜炎は右眼7回，左眼7回みられた。治療は毎回ステロイドの点眼と内服，時に眼注射を行い，症状は数週ほどで軽快した。上強膜炎初発から16年目の健診時CTにて胸骨および脊椎の硬化・肥厚や多発関節炎を指摘され，総合内科にて慢性扁桃炎，掌蹠膿疱症，前胸部病変，脊椎炎などよりSAPHO症候群と診断された。

結論：原因不明で再燃を繰り返す上強膜炎では，鑑別疾患にSAPHO症候群も考慮すべきである。

Abstract　Purpose：To report a case of SAPHO syndrome diagnosed 16 years after the initial onset of episcleritis.

Case：A 51-year-old female presented with ocular pain and redness in the right eye. Her medical history included chronic tonsillitis, erythema nodosum, and palmoplantar pustulosis. There was no abnormality in the intraocular region of the right or left eye. After being diagnosed with episcleritis in the right eye, her right eye was cured with steroid eye drops and oral medication. Ten years later, she came to our hospital again with episcleritis in the right eye, and since then, episcleritis has been seen 7 times in the right eye and 7 times in the left eye. With steroid eye drops, oral medication, and occasional ocular injections, the condition of her eyes always resolved within a few weeks. During a physical examination 16 years after the initial onset of episcleritis, computed tomography（CT）revealed bone sclerosis, thickening, and polyarthritis in the sternum and spine, and a diagnosis of SAPHO syndrome was made based on chronic tonsillitis, palmoplantar pustulosis, anterior thoracic lesions, and spondylitis.

Conclusion：SAPHO syndrome should be considered as a differential diagnosis in patients with episcleritis of unknown cause and recurrent flare-ups.