シクロスポリン全身投与が奏効した壊死性強膜炎の1例

Systemic cyclosporin A was effective in a case of necrotizing scleritis

　85歳女性が7日前からの左眼角膜混濁で受診した。実質型角膜ヘルペスを疑い，アシクロビルと抗生物質の局所投与とプレドニゾロン内服を開始した。5週後に角膜が穿孔した。プレドニゾロンを中止し，治療用コンタクトレンズの装用などで穿孔創は閉鎖したが，その1か月後に壊死性強膜炎が発症した。プレドニゾロン内服を再開し，非ステロイド性抗炎症薬の内服を開始した。さらに4か月後に前房蓄膿が生じたが前房水の培養は陰性であった。多発性胃潰瘍のためにプレドニゾロンを中止した6週後に壊死性強膜炎と思われる黄色結節が鼻側上方に生じた。シクロスポリン内服を開始して眼痛と壊死性強膜炎は軽快した。3か月後の再燃も同様に対処し，以後9か月間治癒した状態にある。副腎皮質ステロイド薬が投与困難または無効な壊死性強膜炎にシクロスポリン内服が奏効した症例である。

An 85-year-old female presented with corneal opacity in her left eye since 7 days before. She was diag-nosed with stromal corneal herpes and received topical acyclovir and antibiotics, and peroral prednisolone. The cornea perforated 5 weeks later. The perforation closed by withdrawal of prednisolone and use of therapeutic contact lens. Ne-crotizing keratitis developed one month later. It was effectively treated by systemic prednisolone and nonsteroid anti-inflammatory agent. Hypopyon developed another 4 months later. Culture of aqueous was negative. Prednisolone had to be discontinued due to multiple gastric ulcer. Necrotizing keratitis developed 6 weeks later. It subsided following peroral cyclosporin A. Another episode 3 months later was controlled by similar means. She has been doing well dur-ing the ensuing 9 months. This case illustrates that systemic cyclosporin A may be effective for necrotizing scleritis re-sistant to corticosteroids.