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患者は40歳女性で臨床診断は網膜色素線条である。精査の目的で蛍光眼底検査を行う予定であったが,フルオレセイン皮内テストで発赤腫脹が強陽性であり,さらに頭痛や眠気などが生じたため重篤な副作用が予想された。後日,麻酔科医による全身管理のもとで手術室にて,蛍光眠底造影検査を行った。フルオレセインの静脈注射後,約2分で血圧低下,胸内苦悶,心電図でのST低下などが出現し,ただちに検査を中止し,麻酔科医により,酸素吸入や交感神経刺激剤,副腎皮質ステロイド剤の注入などの処置が行われた。約60分後血圧,頭痛,四肢の痺れが回復した。フルオレセイン皮内テストは,臨床的にはショックの予想にほとんど価値がないと言われているが,本症例のごとく,重篤な副作用を予知し得た症例があるので,そのような症例では蛍光眼底検査を中止することが望ましい。
A 40-year-old woman was referred to us due to visual impairment in her right eye. We detected angioid streaks and submacular neovascular lesions in both eyes. She had a history of allergy to fluores-cein sodium during skin test 3 years before. Prelimi-nary to fluorescein fundus angiography, we perfor-med intradermal skin testing with 1% fluorescein solution. Marked positive reaction developed as shefelt uncomfortable 15 minutes after skin test and had to lie in bed for 30 minutes. She was then administered 30 mg prednisolone daily for 1 week, after which fluorescein angiography was attempted in the operating room under surveillance by anesth-esiologists. We injected 5ml of 10% fluorescein sodium into the antecubital vein within 5 seconds. Just 2 minutes later, she lost consciousness with decrease in blood pressure but recovered complete-ly. This case illustrates the value of fluorescein skin test in predicting the risk of fluorescein angiogra-phy.
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