後天性免疫不全症候群2例にみられたサイトメガロウイルス網膜炎

Two cases of cytomegalovirus retinitis associated with acquired immunodeficiency syndrome

　症例1は41歳の男性で，後天性免疫不全症候群（AIDS）で内科に入院中，両眼にサイトメガロウイルス（CMV）網膜炎がみられた。ガンシクロビル投与で，CMV網膜炎は鎮静化したが視神経が萎縮し，肺炎を併発して死亡した。症例2は53歳の男性で，不明熱で内科に入院中，human immunodeficiency　virus抗体陽性を指摘された。両眼に糖尿病網膜症があり，右眼にCMV網膜炎がみられたためAIDSと診断され，ガンシクロビル投与と汎網膜光凝固を行った。ガンシクロビルの中止1か月後に，CMV網膜炎が右眼に再発，左眼にも発症した。フォスカーネットを使用し有効であったが，骨髄抑制のため長期投与はできなかった。CMV網膜炎の再発防止には光凝固は無効であった。

We encountered 2 cases of cytomegalovirus retinitis associated with acquired immunodeficiency syndrome (AIDS). The first case was a 41-year-old male with AIDS who presented with cytomegalovirus retinitis (CMV) in both eyes. Although ganciclovir therapy was effective against the CMV retinitis, he lost his vision because of optic disc atrophy in both eyes and died of pneumonia. The second case was a 53-year -old male in whom human immunodeficiency virus antibody was found during hospitalization for a fever of unknown origin. Fundus examination revealed diabetic retinopathy in both eyes. CMV retinitis was detected in the right eye and he was diagnosed as having AIDS. Ganciclovir was given to him for the CMV retinitis, and panretinal laser photocoagulation was performed for diabetic retinopathy in both eyes. CMV retinitis recurred in the right eye and occurred in the left eye 1 month after ganciclovir was stopped. Foscarnet was effective against the CMV retinitis, but had to be discontinued because of myelosuppression. Laser photocoagulation was ineffective in preventing recurrence of CMV retinitis.