視神経障害を初発とした悪性リンパ腫による圧迫性視神経症の1例

Optic nerve disorder as the initial manifestation in a case of malignant lymphoma with compression optic neuropathy

　50歳男性の右眼に急性の視力低下が生じた。当初，後部虚血性視神経症が疑われていたが，髄液検査にて悪性リンパ腫が発見され，再度の画像検査にて右蝶形骨洞縁に視神経を圧迫する占拠性病変を認めた。悪性リンパ腫による圧迫性視神経症と診断し，髄腔内と全身への化学療法を施行し，視力，視野は改善した。視神経症を初発として悪性リンパ腫が発見された稀な症例である。

A 50-year-old male noted a sudden blurring of vision in his right eye. His visual acuity was 0.2 right and 1.2 left. Horizontal hemianopia was detected in the right eye. The findings were suggestive of posterior ischemic optic neuropathy. Further work-up showed malignant lymphocytes in the spinal fluid. Radiologically, a space-occupying mass was detected along the edge of the right sphenoid sinus compressing the optic nerve. He was diagnosed as malignant lymphoma with compression-type optic neuropathy. Systemic and intaspinal chemotherapy induced normalization of vision and visual field. This case illustrates that malignant lymphoma may manifest as optic neuropathy.