粟粒結核の治癒30年後に眼結核が再発した1例

Ocular recurrence thirty years after cure of miliary tuberculosis

　46歳の女性に，粟粒結核の治癒30年後，眼結核が再発した。初診時の右眼底には，網膜下出血を伴う隆起性病変と色素沈着を伴う網脈絡膜萎縮巣があり，両眼底には小さな斑状萎縮巣が多数みられた。ツベルクリン反応は15×14mmであった。ツベルクリン注射後，右眼の前房と硝子体中に炎症細胞が多数出現し，右眼底の隆起性病変は約2倍に拡大した。抗結核療法後，右の前部ぶどう膜炎の所見は消失し，右眼底の隆起性病変は次第に瘢痕萎縮化した。本症例の眼底所見は，conglomerate tuberculosisの活動病変および陳旧病変と，acute miliary lesionの陳旧病変と判断された。

A 46-year-old female presented with impairedvisual field in her right eye. She had a history ofmiliary tuberculosis of two years' duration 30 yearsbefore. We detected a large elevated lesion withsubretinal hemorrhage and retinochoroidal atrophyin the right eye. Additionally, there were numerousscarred patches in both fundus. Visual acuity was1.2 in either eye. We detected calcified tuberculouslesions in the brain and the lungs. Tuberculin skintest was positive by 15×14 mm. Four days after theskin test, inflammatory cells appeared in the anterior chamber and the vitreous. The elevated lesionin the rightl fundus enlarged to twice the originalsize. The visual acuity decreased to counting fingers. Treatment with systemic isoniazid andrifampicin resulted in improvement of uveitis andin scarring of the elevated lesion. The fundus findings were interpreted as residues of earlier acutemiliary and conglomerate tuberculosis withreactivation of the latter.