多彩な眼症状を呈した肥厚性硬膜炎の1例

A case of hypertrophic pachymeningitis with multiple ocular manifestations

　61歳女性が左眼結膜充血で受診した。左眼に虹彩毛様体炎，乳頭浮腫，毛様体扁平部の黄白色隆起性病変があり，結核が疑われた。頭痛と左側の多発性脳神経障害があり，磁気共鳴画像検査（MRI）で肥厚性硬膜炎と診断した。抗結核薬で諸症状は改善しなかった。硬膜生検で結核は否定された。ステロイドパルス療法で眼症状は著明に改善し，MRIでの硬膜肥厚は縮小した。肥厚性硬膜炎の多くは原因不明であるが，原因として結核が疑われた本例では，治療方針の決定に硬膜生検が有用であった。

A 61-year-old female presented with left conjunctival hyperemia. Her left eye showed iridocyclitis, papilledema, and exudative lesions in the pars plana. The findings were suggestive of tuberculosis. She had also headache and multiple cranial nerve disorders. Magnetic resonance imaging (MRI) led to the diagnosis of hypertrophic pachymeningitis. Antituberculous medications failed to improve the clinical findings. She was then treated by pulsed corticosteroid after tuberculosis was ruled out by biopsy of dura mater. The ocular manifestations markedly improved followed by reduction of dural thickening. While the underlying cause may often remain obscure in pachymeningitis, biopsy of dura mater was useful as a guide in therapeutics in the present case in which tuberculosis was initially suspected.