滲出性網脈絡膜炎として初発した成人T細胞白血病

Exudative retinochoroiditis in an adult with T-cell leukemia

　白血病細胞の眼内浸潤を初発症状とした成人T細胞白血病（ATL）の1例を経験した。症例は宮崎県出身の45歳女性，左眼硝子体混濁と下鼻側静脈周囲の滲出性病変で初発した。急性網膜壊死の眼底所見を示し，プレドニゾロン，アシクロビルによる治療に抵抗した。病巣は徐々に拡大し，眼底の3分の2周に拡がった。初診から3か月後に初めて末梢血中にATL細胞が出現した。硝子体生検によって，T細胞系異型リンパ球を多数認め，ATL細胞の眼内浸潤と判明した。

A 45-year-old female presented with flotaters in her left eye. The affected eye manifested vitreous opacity, retinochoroidal exudation, retinal hemorrhage and retinal vasculitis in the inferior nasal sector. Hematological findings were within normal limits except leukocytosis. She was tentatively diagnosed as exudative chorioretinitis. Systemic corticosteroid resulted in further exacerbation of exudative lesions. Systemic acyclovir and gamma-globulin were added for suspected acute retinal necrosis but proved futile. Diagnostic vitrectomy at 3 months after onset showed numerous atypical lymphocytes with irregularly lobulated nuclei which were consistent with adult T-cell leukemia (ATL). ATL cells were also detected in the peripheral blood. The patient happened to be from Miyazaki Prefecture in southern Kyushu, where ATL is endemic.