Epstein-Barrウイルスとの関連が疑われたStevens-Johnson症候群の治療奏効例

Fair therapeutic outcome in a case of Stevens-Johnson syndrome presumably associated with Epstein-Barr virus

　角膜上皮形成術が有効であったStevens-Johnson syndromeの1例を経験した。症例は7歳女児で，発熱・全身皮膚粘膜の多形性滲出性紅斑・偽膜性結膜炎で発症した。急性期に，毎日の偽膜除去，特製の有窓義眼の装着等を行うことにより瞼球癒着を防止できた。1年後の瘢痕期には結膜嚢が良く保たれていたため，角膜瘢痕組織に対して角膜上皮形成術を行い，良好な視力を得た。本症の治療では，発症早期から結膜嚢の形成を試みることが重要であると思われた。手術前のEBV関連血清抗体価では，VCA-lgGの異常高値やEA-lgG陽性などがあり，EBVの活性化が推定された。

A 7-year-old girl developed high fever, exudative multiform erythema and pseudomembranous conjunctivitis. Symblepharon could be prevented by daily removal of pseudomembranes and by wearing a modified ocular prosthesis during the acute phase. One year later, there was scarring of the cornea in both eyes. Symblepharon was present but negligible and the conjunctival fornix was intact. Serological studies for Epstein-Barr virus showed elevated titers of IgG antibodies to viral capsid antigens and relatively high titers of IgG antibodies to early antigens. The findings suggested activation of Epstein-Barr virus. She was then treated by keratoepithelioplasty with fair visual outcome. The present case illustrates the importance of prevention of symblepharon in the treatment of ocular manifestations of Stevens-Johnson syndrome.