小児の視神経炎に網膜前出血を併発した多発性硬化症の1例

Optic neuroretinitis with retinal hemorrhage in a child of multiple sclerosis

（G−8AM−15）　4歳の女児が高熱，意識障害とけいれん発作ののち複視を生じて受診した。矯正視力は右0.6，左0.7で，右眼に上斜視があり，水平眼振があった。眼底などには異常はなかった。小脳症状，滑車神経と聴神経麻痺，脳の画像診断などから多発性硬化症が疑われた。ステロイド薬の全身投与開始2週後に左眼痛が生じた。左眼に視神経乳頭炎と網膜静脈の蛇行があり，その2日後に左眼後極部一帯に網膜前出血が生じた。さらにその1か月後に右眼に視神経乳頭炎が発症した。ステロイド薬の全身投与を続けた。両眼とも最終的に寛解し，視力が回復した。左眼の網膜前出血は網膜血管炎によると解釈された。

A 4-year-old girl developed high fever, loss of consciousness and seizures followed by diplopia. Her corrected visual acuity was 0.6 right and 0.7 left. Her right eye was superiorly displaced and showed monoocular horizontal nystagmus. She was diagnosed as multiple sclerosis based on cerebellar symptoms, trochlear and auditory palsy and brain imaging. Left eye pain developed 2 weeks after start of systemic corticosteroid treatment. The left eye showed neuroretinitis and tortuous veins. Massive preretinal hemorrhage developed 2 days later. Neuroretinitis was found in the right eye another one month later. Following systemic corticosteroid, both eyes recovered with full visual acuity. The preretinal hemorrhage in her left eye appeared to be secondary to retinal vasculitis.