ミエロペルオキシダーゼ—抗好中球細胞質抗体価が上昇した両眼性周辺部角膜潰瘍の1例

A case of bilateral marginal corneal ulcer with elevated serum myeloperoxidase:antmeutrophil cytoplasmic autoantibodies

　Myeloperoxidase-antineutrophil cytoplasmic autOantibodies （MPO-ANCA）の上昇がある重篤な両眼性周辺部角膜潰瘍の1症例を経験した。症例は68歳女性で，10か月前から左眼，1か月前から右眼の眼痛，視力低下を主訴に受診した。初診時視力は右0.02，左光覚弁で両眼に充血と全周性の高度の周辺部角膜潰瘍を認めた。検査所見で白血球数赤沈，CRP，リウマトイド因子（RF）ともに亢進し，MPO-ANCAも45 EU／mlと亢進していた。治療としてプレドニゾロン内服を20mg投与し，その後全身的にMPO-ANCA関連血管炎の存在が疑われたため60mgに増量した。潰瘍は約4か月でほぼ鎮静化し，白血球数赤沈，CRP,RF値は正常化し，MPO-ANCAの値も低下した。今後，周辺部角膜潰瘍の基礎疾患の1つとしてMPO-ANCA関連血管炎の存在を検索することが必要と考えられた。

A 68-year-old female presented with ocular pain and blurred vision persisting for 10 months in the left eye and for one month in the right. Her visual acuity was 0.02 right and light perception left. Both eyes showed severe marginal corneal ulcer with conjunctival and scleral injection. The ulcers extended to form ring ulcers. Hematological studies showed leukocytosis, elevated erythrocyte sedimentation rate, CRP, rheumatoid factors and myeloperoxidase-antineutrophil cytoplasmic autoantibodies (MPO-ANCA) . She was treated with systemic prednisolone 20 mg/kg per day. The dosage was later increased to 60 mg/kg per day under suspicion of MPO - ANCA-related vasculitis syndrome. The corneal ulcers healed four months after initiation of treatment associated with normalized hematological findings. This case illustrates that marginal corneal ulcer may develop as manifesta-tion of MPO-ANCA-related vasculitis syndrome.