限局性網脈絡膜萎縮が生じた多発性脈絡膜炎と全ぶどう膜炎の1例

A case of multifocal choroiditis and panuveitis resulting in localized retinochoroidal atrophy

　ぶどう膜炎として半年前から治療されていた69歳の女性が受診した。矯正視力は両眼とも0.5であった。前房の混濁と細胞が両眼にあり，右眼には網膜血管に沿う滲出斑が散発していた。左眼には同様の滲出斑が耳側周辺のみにあった。螢光眼底造影で網膜血管の透過性亢進と乳頭の螢光染があった。諸検査の結果サルコイドーシスは否定され，原因不明の全ぶどう膜炎と診断した。4年後の受診時の視力は，右0.04，左0.7であつた。右眼には強い硝子体混濁があった。両眼の眼底周辺部に打ち抜き萎縮斑と新鮮な滲出斑が散在していた。以上の所見から，発症から数年を経ても新鮮および陳旧化した限局性病巣が併発することを特徴とする多発性脈絡膜炎と全ぶどう膜炎multifocal choroiditis and pan-uveitisと診断した。

A 69-year-old female had been treated for presumed uveitis since 6 months before. Her best visual acuity was 0.5 in either eye. Both eyes showed cells and flare in the aqueous. The right fundus showed exudates along the retinal vessels. The left eye showed similar exudates in the temporal periphery only. Fluorescein angiography showed hyperpermeability of retinal vessels and hyperfluorescence of the disc. Sarcoidosis was ruled out on systemic and laboratory studies. She was diagnosed as panuveitis of unclassified nature. When she was seen 4 years later, the visual acuity was 0.04 right and 0.7 left. Dense vitreous opacity was present in the right eye. Punched-out atrophic lesions and fresh exudates were present in the peripheral fundus in both eyes. We diagnosed her, in retrospect, as multifocal choroiditis and panuveitis manifesting fresh and atrophic fundus lesions years after onset.