滲出性網膜剝離を伴う汎ぶどう膜炎を呈した血管炎性肉芽腫症の1例

A case of vasculitic granulomatosis with panuveitis accompanied by exudative retinal detachment

要約　背景：多発血管炎性肉芽腫症の稀な眼合併症である網脈絡膜病変を伴った症例を経験したので報告する。

症例：57歳，女性。慢性副鼻腔炎の既往があり，家族歴はない。初診時の視力は右（0.4），左（0.02）であった。毛様充血，両硝子体混濁，両滲出性網膜剝離，脈絡膜の肥厚を認め，フルオレセイン蛍光眼底造影検査にて両眼底に滲出斑に一致した蛍光漏出所見を認めた。尿潜血3＋，胸部CTにて両側の肺野に多発小結節影を認め，血液検査にてPR3-ANCA，MPO-ANCAの上昇を認めた。また腎生検にて糸球体の炎症性癒着所見を認めた。ステロイドパルス療法を施行後に副腎皮質ステロイド，メトトレキサートの内服加療を行った。治療に反応し，消炎が得られ，滲出性網膜剝離も徐々に消退し，滲出斑もすべて瘢痕化し，寛解に至った。

結論：多発血管炎性肉芽腫は滲出性網膜剝離の原因となりうる。

Abstract　Background：We present a case of granulomatosis with polyangiitis accompanied by uveitis symptoms and chorioretinal involvement.

Case：The patient was a 57-year-old woman. At the first visit, she had bilateral ciliary hyperemia, bilateral vitreous opacity, bilateral exudative retinal detachment, and choroidal thickening, and fluorescein angiography revealed findings of fluorescence leakage consistent with exudative spots on both fundi. There was occult blood in urine（3＋）, chest CT showed multiple nodular shadows in both lung fields, and blood tests revealed elevated PR3-ANCA and MPO-ANCA levels. Renal biopsy findings revealed glomerular inflammatory adhesions. After undergoing steroid pulse therapy, she was treated with oral corticosteroids and methotrexate. The patient responded to the treatment, and the inflammation disappeared, the serous retinal detachment gradually disappeared, and all the exudative spots turned into scars, resulting in remission.

Conclusion：Granuloma with polyangiitis can cause exudative retinal detachment.