眼内白血病細胞浸潤の2症例

Two cases of leukemia with ocular involvement

　白血病の眼合併症として稀な白血病細胞の直接浸潤の2例を経験した。症例1は59歳男性で，成人T細胞性白血病リンパ腫（ATLL）の経過中に，両眼に前房蓄膿を伴った虹彩炎を生じ，ステロイド治療に反応しなかった。前房穿刺を行ったところ，前房水中にATL細胞が認められ，さらにPCR法によりヒトT細胞白血病ウイルスⅠ型（HTLV—Ⅰ）のウイルスゲノムが検出された。化学療法と放射線照射（総量30Gy）の併用によりぶどう膜炎は消退した。症例2は71歳男性で，急性骨髄性白血病（AML）の経過中に視神経乳頭浮腫を生じた。MRI検査で視神経の著明な腫大を認めたため，白血病細胞が右視神経に選択的に浸潤したものと考えた。化学療法を開始したが，敗血症を併発し無菌室での治療のため放射線照射は施行できず，3か月後には失明に至った。放射線療法の有無が，眼合併症の予後を左右すると考えられた。

We observed two cases of ocular infiltration of leukemia cells. A 59-year-old man presented with severe uveitis and hypopyon in both eyes. He had been diagnosed with adult T-cell leukemia/lymphoma (ATLL) 4 months before. Topical and systemic corticosteroid failed to influence the eye findings. Biopsy of anterior chamber showed atypical lymphocytes typical for ATLL as well as DNA fragments of human T-cell leukemia virus type I by polyme-rase chain reaction (PCR). The uveitis subsided after chemotherapy and radiation totalling 30 Gy. Another 71-year-old man presented with acute visual loss in his right eye. He had been diagnosed with acute myeloblastic leukemia (AML) 22 months before. Funduscopy showed papilledema in the right eye. Magnetic resonance imaging (MRI) showed swollen right optic nerve and led to the diagnosis of infiltrative optic neuropathy. No radiation was performed as the patient was staying in a sterile room for septicemia. His visual acuity decreased to no light perception 2 months later. These cases illustrate that the visual prognosis in patients of leukemia with ocular infiltration may be decided by the availability of radiation in addition to chemotherapy.