原田病へのステロイド全身投与後にインスリン依存型糖尿病を発症した1例

A case of insulin dependent diabetes mellitus following treatment by systemic corticosteroids for Vogt-Koyanagi-Harada disease

（P3-1-24）　29歳の男性が頭痛，咳嗽，急激な視力低下を訴え．県西部浜松医療センター眼科に紹介された。両眼底後極部の漿液性網膜剥離と，螢光眼底撮影での網膜下螢光色素貯留所見から原田病と診断し，ステロイドを全身投与したところ，発症10か月後に夕焼け状眼底を呈し寛解した。発症13か月後（ステロイド投与中止3か月後）にインスリン依存型糖尿病（IDDM）を発症し，血糖コントロールは著しく不良である。HLA検査ではIDDMと関連するDR9,DQB1^＊0303が検出された。IDDMの発症には，（1）原田病と共通する自己免疫機序が介在する可能性，（2）ステロイド投与が関与した可能性，（3）偶然発症の可能性が考えられるが，現段階では，（1）（2）の証明は困難である。

A 29-year-old male presented with acute visual impairment, cough and headache of one week's duration. Both eyes showed serous retinal detachment in the posterior fundus. Fluorescein angiography showed leakage and subretinal dye pooling. He was diagnosed as Vogt-Koyanagi-Harada (VKH) disease. Treatment with systemic betamethasone was followed by resolution of uveitis and by fundus depigmentation, or sunset glow, 10 months later. The amount of betamethasone totalled 496 mg over a period of 11 months. Insulin-dependent diabetes mellitus (IDDM) developed 13 months after onset. Control of blood sugar was very poor. HLA analysis showed DR9 and DQB1 ^* 0303 which are known to be related with IDDM. We presume that IDDM developed as a coincidence rather than consequent to systemic corticosteroid or autoimmune process related to VKH disease.