多発性網膜黄白色斑と虹彩結節で初発したVogt—小柳—原田病

Iris nodules and multiple yellow-white retinal flecks masqueraded in a case of Vogt-Koyanagi-Harada syndrome

　従来報告のない多発性網膜黄白色斑で初発した54歳男性のVogt—小柳—原田病を経験した。螢光眼底検査では脈絡膜循環障害を認め，黄白色斑はAPMPPEに類似した螢光像を示し，EOGでL／D比が低下していたことから，黄白色斑は脈絡膜循環障害により網膜色素上皮細胞が障害されたものであることが示唆された。

　本症例での黄白色斑と他疾患での黄白色斑との鑑別には，螢光眼底検査や全身的検索が必要であることを強調した。虹彩結節は，本病の発病初期にも認められることを確認した。

A 54-year-old male presented with impaired vision and hyperemia in both eyes since 18 days before. He manifested iris nodules of Koeppe and multiple small yellow-white flecks in the retina without serous retinal detachment. Fluorescein angiographic findings simulated those of acute posterior multifocal placoid pigment epitheliopath-y, APMPPE, with delayed dye filling in areas corre-sponding to the white-yellow flecks. The electrooculogram showed depressed L/D ratio dur-ing the initial phase. The findings seemed to sug-gest that the white-yellow flecks were located at the retinal pigment epithelium damaged by circula-tory disorders in the choriocapillaris. This case illustrates the value of fluorescein angiography in the differential diagnosis of white-yellow flecks of the retina. Iris nodules may be pathognomic in relatively early stage of Vogt-Koyanagi-Harada syndrome.