完全寛解期に視神経浸潤より急性骨髄性白血病の再発が発見された1例

Infiltration of the optic nerve as the initial sign of recurrence in a case of acute myelogenous leukemia in the remission stage

　42歳の男性が21か月前に急性骨髄性白血病を発症し，2回の化学療法で2か月前に完全寛解した。1か月前に右眼に激しい疼痛が生じ，2週前に右眼乳頭の発赤腫脹が発見され，4日前に右眼視力が零になった。右眼には眼球運動障害があり，乳頭に高度の腫脹と黄斑部を含む網膜浮腫，硝子体中に黄白色塊が浮遊していた。蛍光眼底造影で網膜の血流が途絶していた。腰椎穿刺で白血病細胞があり，急性骨髄性白血病の再発と診断された。抗癌剤投与と放射線照射で白血病は寛解したが，右眼視力は回復しなかった。いったん寛解した急性骨髄性白血病が，視神経への細胞浸潤を初発症状として再発しうることを示す症例である。

A 42-year-old male was diagnosed as acute myelogenous leukemia 21 months before. A complete remission was achieved 2 months before after systemic treatment with chemotherapeutic agents. He developed severe pain in his right eye one month before. Hyperemic swelling of the right optic disc was detected 2 weeks before. The visual acuity decreased to no light perception 4 days before. When seen by us, the right eye showed impaired motility, severe optic disc swelling with retinal edema, and floaters in the vitreous. Fluorescein angiography showed cessation of retinal circulation. Lumber puncture showed leukemia cells, leading to the diagnosis of recurrence of leukemia. Systemic chemotherapy and radiation induced remission of leukemia but no improvement in visual acuity in the right eye. This case illustrates that infiltration of optic nerve by leukemia cells may be the initial manifestation of recurrence of leukemia after previous remission.