AIDSに伴うサイトメガロウイルス網膜炎の1例

A case of cytomegalovirus retinitis associated with AIDS

　AIDSに伴うサイトメガロウイルス網膜炎の1例を経験し，ganciclovirによる治療を行った。通常の維持量では網膜炎が鎮静化しなかったため，通常維持量の2倍である10mg／kg／日，週6日投与を行った。ganciclovirの副作用である白血球減少は中等度にみとめられた（1700／μl）が，その他の重篤な副作用はなかった。ganciclovir投与開始時に網膜障害が軽度であった左眼の視力予後は良好であったが，既に重篤な網膜炎のあった右眼の視力予後は不良であった。サイトメガロウイルス網膜炎では早期のganciclovir投与が有効であると思われる。

A 17-year-old male presented with blurring of his right eye. He had been diagnosed as hemophilia A at the age of 1 year and undergone repeated blood transfusion. He was found to be positive for human immunodeficiency virus (HIV) 5 years before. He developed AIDS-related candida eso-phagitis 1 year before. The visual acuity was 1.0 for either eye.Both eyes manifested retinal hemor-rhage and exudates with sheathing of vessels.Ele-vated titer of antibody for cytomegalovirus led to the diagnosis of cytomegalovirus retinitis. We initiated systemic ganciclovir treatment 6 months after onset. While the retinitis responded well to double dosis at 10mg/kg/day, ganciclovir had to be discontinued because of pneumonia after 9 months of therapy. Retinal detachment developed in both eyes 4 days later. Death followed 6 weeks after onset of pneumonia. We advocate early diagnosis and initiation of treatment with systemic ganci-clovir for this condition.