腎移植後慢性拒絶反応患者に合併したサイトメガロウイルス網膜炎の1例

Cytomegalovirus retinitis in a case with chronic rejection after kidney transplantation

　49歳男性が，右眼の飛蚊症と視力低下で受診した。18歳時に慢性腎不全と診断され，30歳時に血液透析を開始し，9か月前に腎移植を受け，免疫抑制薬の投与中であった。受診1か月前の腎生検で慢性拒絶反応が確認された。白血球サイトメガロウイルス抗原が陽性であり，右眼のサイトメガロウイルス網膜症と診断した。腎機能とガンシクロビル血中濃度をモニタリングしながらガンシクロビルの全身投与と免疫抑制薬の減量を行い，腎不全の悪化なしに眼底病変は消退した。

A 49-year-old man presented with seeing floaters and decreased visual acuity in his right eye. He had been diagnosed with chronic renal failure at the age of 18. Hemodialysis had started at age 30. Kidney transplantation was performed 9 months before followed by systemic immunosuppressants. Chronic rejection had been detected by renal biopsy 1 month before. He was positive for leukocyte cytomegalovirus and was diagnosed with cytomegalovirus retinitis in the right eye. He was then treated by systemic ganciclovir and tapering of immunosuppressants under close monitoring of renal function and blood concentration of ganciclovir. The fundus lesion subsided without side effects.