ぶどう膜炎と続発性緑内障を認めた胸肋鎖骨過形成症の1例

A case of sternocostclavicular hyperostosis with uveitis and secondary glaucoma

　胸肋鎖骨過形成症は胸骨，肋骨，鎖骨に異常骨化をきたす自己免疫疾患と考えられているが，これまで眼合併症の報告は知られていない。症例は59歳男性。前胸壁の疼痛・腫脹を主訴とし，CRP, ALP，赤沈，血清　IgG, lgA，抗核抗体の上昇が認められ，胸部X線で胸肋鎖骨の著明な肥厚，骨シンチグラムで　RIの集積像が認められ，胸肋鎖骨過形成症と診断された。眼科的には両眼に軽度の前房混濁，角膜後部沈着物等の前部ぶどう膜炎の所見を認め，眼圧右18mmHg左33mmHg，左眼隅角は　Shaffer II,pigment II，虹彩前癒着を認めた。左眼乳頭に緑内障性陥凹を認め，左眼視野は鼻側階段を認め，左眼続発性緑内障が考えられた。HLAはB52, B61, Cw3, DR2, DR12が陽性であり，仙腸関節の異常も認められた。本疾患の病因については，免疫異常をはじめ多方面からの検討が必要であることが考えられた。

A 55-year-old male presented with chest pain and purpura in the extremities. He manifested bamboo spine. Laboratory studies revealed increase in CRP, ALP, ANA, serum IgG and IgA values. Scintigraphy with radioactive Tc-methylene di-phosphonate showed increased uptake in the ster-nocostclavicular region and led to the diagnosis of sternocostclavicular hyperostosis. Slitlamp exami-nation showed aqueous opacity and keratic precipi-tates in both eyes. Left eye was diagnosed as secon-dary glaucoma due to intraocular pressure of 33 mmHg, anterior peripheral synechia, glaucomatous disc cupping with corresponding visual field defect. Uveitis was iridocyclitic type. Fluorescein angio-graphy showed no chorioretinal lesions. HLA anal-ysis showed positive for B52, B61, Cw3 and DR12. The present case is the first reported one of ster-nocostclavicular hyperostosis with uveitis in Japan.