ステロイド大量投与中に急激な片眼の視力低下を生じた原田病の1症例

A case of sudden visual loss during high-dose corticosteroid therapy for Harada disease

（18-レセ1-31）　両眼に典型的な原田病を発症した40歳女性が，メチルプレドニゾロン200mgを1日量として投与を受けた。6週後に視力が改善した。漿液性網膜剥離が再発したためにステロイドの大量療法が再開された。5週後に両眼とも視力が正常化した。その6週後に左眼の視力が0.3に低下し，プレドニゾロン内服を40mgに増量した。8日後に当科に紹介受診したときの左眼視力は0.08であった。炎症所見はなく，網膜剥離ないし乳頭の発赤はなかった。ステロイドを減量し，アスピリンを投与することで視力は緩慢に回復し，4か月後に左眼視力は0.9に回復した。ステロイド大量投与が視神経ないし網膜の障害の原因となった可能性が推定された。

A 40-year-old female with bilateral Harada disease was treated by systemic methylprednisolone at the initial daily dosis of 200 mg. Her visual acuity recovered 6 weeks later. Due to recurrence of serous retinal detachment, she was again treated by 250 mg methylprednisolone which was later tapered off. Visual acuity recovered 5 weeks later. Another 6 weeks later, her left visual acuity decreased to 0.3 necessitating treatment by 40 mg prednisolone. The left visual acuity was 0.08 when she was referred to us 8 days later. There was no sign of intraocular inflammation, retinal detachment, nor disc hyperemia. Withdrawal of corticosteroid and peroral aspirin resulted in gradual recovery of vision which reached 0.9 four months later. It is presumed that high-dose cortcosteroid therapy may have induced damage to the optic nerve or the retina.