ASPPCや虹彩肉芽腫など多様な所見を呈した梅毒性ぶどう膜炎の3例

Three cases of syphilitic uveitis with various findings including ASPPC and iris granuloma

要約　目的：Acute syphilitic posterior placoid chorioretinitis（ASPPC）や稀な虹彩肉芽腫を認めた梅毒性ぶどう膜炎を経験したので報告する。

症例1：55歳，HIV陽性の男性。主訴は左眼の視力低下と眼痛。初診時矯正視力は右0.6，左0.3，左眼の虹彩肉芽腫，両眼の著明な網膜血管炎とASPPCを認めた。ペニシリン内服を行い，最終矯正視力は右0.9，左1.2に改善し眼炎症は鎮静化した。

症例2：41歳，男性。主訴は両眼視力低下と充血。初診時矯正視力は右1.5，左1.0，両眼の肉芽腫性虹彩炎と軽度の網膜血管炎を認めた。1週間後，左眼にacute macular neuroretinopathy様の所見が出現した。持続性ペニシリン製剤の筋肉注射を行い眼所見は改善し，最終矯正視力は左右とも1.5と良好であった。

症例3：60歳，男性。主訴は左眼霧視。左矯正視力は0.2でASPPCの所見を認めた。ペニシリン内服を行い，網膜外層障害は改善し最終矯正視力は左1.0まで回復した。

結論：梅毒性ぶどう膜炎は多様な所見を呈するが視力予後は良好であった。全身検査や患者背景からもアプローチして早期に診断し，内科と連携して治療を進める必要がある。

Abstract　Purpose：To report three cases of syphilitic uveitis with acute syphilitic posterior placoid chorioretinitis（ASPPC）or rare iris granuloma.

Case 1：A 55-year-old HIV-positive male presented with a chief complaint of decreased vision and eye pain in the left eye. The best corrected visual acuity was 0.6 in the right eye and 0.3 in the left eye. An iris granuloma was found in the left eye, and marked retinal vasculitis and ASPPC in both eyes. Oral penicillin was administered, and his visual acuity improved to 1.0 in right eye and 1.2 in the left eye. The ocular inflammation subsided.

Case 2：The patient was a 41-year-old male. His chief complaints were decreased visual acuity and conjunctival hyperemia in the both eyes. The best corrected visual acuity was 1.5 in the right eye and 1.0 in the left. Both eyes showed granulomatous iritis and mild retinal vasculitis. One week later, acute macular neuroretinopathy-like findings were observed in his left eye. After intramuscular injection of a long-acting penicillin preparation, the ocular inflammation improved. The final visual acuity was 1.5 in the both eye.

Case 3：The patient was a 60-year-old male. His chief complaint was blurred vision in the left eye. The best corrected visual acuity was 0.2 in the left eye and ASPPC was observed. Oral penicillin was administered. After treatment, the outer retinal layer damage improved and the final visual acuity recovered to 1.0.

Conclusion：Although syphilitic uveitis shows various findings, the visual prognosis is good after treatment. To start treatment early, early diagnosis based on systemic examinations and the patient's background in cooperation with internal medicine is important.