傍乳頭肉芽腫を呈した視神経炎の1例

Optic neuritis in a case of parapapillary granuloma

　11歳女児が髄膜炎の疑いで小児科に入院中に，右眼の視力低下を自覚した。矯正視力は，右0.03，左1.2であった。右眼の視神経乳頭は発赤腫脹し，その下方に肉芽腫様病変があり，傍乳頭肉芽腫を伴う視神経炎と診断した。当初サルコイドーシスを疑い，ステロイドパルス療法で病変は軽快した。しかし，全身検査でサルコイドーシスの所見がないこと，抗トキソカラ抗体が陽性であること，犬飼育歴があることから，眼トキソカラ症であると診断した。

A 11-year-old girl noted blurring of vision in her right eye during treatment for presumed meningitis. Her corrected visual acuity was 0.03 right and 1.2 left. Funduscopy showed hyperemic swelling of the optic disc in the right eye. A granulomatous mass was present inferior to the disc. The condition was diagnosed as optic neuritis secondary to parapapillary granuloma. Systemic pulse therapy with corticosteroid was started under the tentative diagnosis of sarcoidosis and resulted in the resolution of pathological changes. She was finally diagnosed as ocular toxocariasis based on negative findings of sarcoidosis, positive titer for toxocara antibody, and the history of keeping a dog in her house.