単純ヘルペス脳炎の既往のある急性網膜壊死の1例

A case of acute retinal necrosis after herpes simplex encephalitis

　単純ヘルペス脳炎の既往のある43歳の男性の左眼に急性網膜壊死が発症した。患者は本症発症の10か月前に単純ヘルペス脳炎に罹患し，acyclovirとγ-globulinの投与により治癒し，後遺症もなく生活していた。突然視力障害が出現し，その特徴的な眼底所見などから急性網膜壊死と診断し，acyclovir，steroid，aspirinを投与し，網膜光凝固術を行った。約2か月後には円孔を形成し，網膜剥離が出現したため，強膜輪状締結術と硝子体切除術を行った。経過中の血清および前房水の単純ヘルペスウイルス1型に対する抗体価が上昇しており，手術時に得られた眼内液の抗体率が高値を示し，病因として単純ヘルペスウイルス1型が考えられた。

A 43-old-male presented with typical clinical manifestations of acute retinal necrosis in his left eye. He had suffered from herpes simplex encepha-litis 10 months before. Clinical cure without se-quealae had set in after 2 months of treatment with systemic acyclovir and gammaglobulin.

We treated the patient with systemic acyclovir,corticosteroid and aspirin. Photocoagulation was applied to the peripheral retina. Retinal detachment with a break developed 2 months later and was treated by vitrectomy and buckling procedure. An increase in antibody titer for herpes simplex virus type 1 was confirmed in the serum and the aqueous. The vitreous showed elevated antibody quotient. These findings suggested that herpes simplex virus type 1 was involved in the pathogenesis of acute retinal necrosis.