網脈絡膜炎が先駆した亜急性硬化性全脳炎

A case of subacute sclerosing panencephalitis with retinochoroiditis as the initial manifestation

　8歳男児が右眼の黄斑変性で紹介された。矯正視力は右0.2，左1.2であった。その21か月後に左眼の黄斑部と周辺部に滲出斑と血管炎が生じたが，1か月で消炎し，黄斑部は右眼に酷似する瘢痕病巣になった。この頃から軽度の健忘症状が現れ，続いてミオクローヌス様不随意運動と意識消失発作が生じた。髄液のPCR解析で麻疹ウイルスが検出され，亜急性硬化性全脳炎と診断された。亜急性硬化性全脳炎では，精神神経症状の出現以前に，特徴的な網脈絡膜炎が先駆することがあることを示す1例である。

An 8-year-boy was referred to us for macular degeneration in his right eye. His corrected visual acuity was 0.2 right and 1.2 left. Exudative lesions and vasculitis developed in the macula and the peripheral retina 21 months later. The macular lesion underwent spontaneous resolution leaving pigmented scarring similar to the right eye. The patient developed mild amnesia followed by neurological symptoms including myoclonus and unsteady gate. He was diagnosed with subacute sclerosing panencephalitis (SSPE) after measles virus was identified in the cerebrospinal fluid processed by reverse transcription-polymerase chain reaction (RT-PCR) . This case illustrates that retinochoroiditis may be a precursor of SSPE before manifestation of neurological symptoms.