眼窩先端部症候群として発症した眼窩真菌感染症の1例

A case of fungal infection of the orbit presenting as orbital apex syndrome

（P−340）　75歳女性が，5週間前からの右眼窩先端部症候群で紹介され受診した。1か月前から右三叉神経痛に対して副腎皮質ステロイド薬治療を受けていた。矯正視力は右眼0，左眼1.0であった。磁気共鳴画像検査（MRI）で，右後篩骨洞から眼窩先端部に浸潤性病変があり，真菌感染が疑われた。眼窩前方アプローチによる眼窩生検の結果は炎性偽腫瘍であった。抗真菌薬と副腎皮質ステロイド薬の全身投与と放射線照射で加療したが，初診から5か月後に左眼視力が消失した。経鼻的に篩骨洞と視神経管開放術を行い，右後篩骨洞に大量の真菌塊が発見され，アスペルギルスが同定された。手術の3週後に患者は真菌の脳内浸潤で死亡した。眼窩先端部症候群を呈する真菌症はしばしば致死的であり，診断と治療には他科との十分な連携が必要である。

A 75-year-old woman was referred to us for orbital apex syndrome in her right eye since 5 weeks before. She had been receiving systemic corticosteroid for trigeminal neuralgia during the past one month. Her corrected vis-ual acuity was no light perception right and 1.0 left. Magnetic resonance imaging (MRI) showed a large invasive lesion in the ethmoid sinuses and orbital apex of the right eye. A fungal infection was suspected and systemic antifuncal treat-ment was initiated. Biopsy of the orbit by anterior approach showed an inflammatory pseudotumor, leading to addi-tional radiation and corticosteroid. Five months after her initial visit, the visual acuity in the left eye decreased to no light perception. Transnasal ethmoidectomy and decompression of the optic canal showed a fungal mass in the right ethmoid sinus which was identified as aspergilloma. The patient died of cranial infection 3 weeks later. Orbital apex syndrome caused by fungal infection is often life-threatening. Ophthalmologists, together with other specialists, should take the initiative for proper diagnosis and treatment.