眼部帯状疱疹による眼窩尖端症候群の1例

Varicella Zoster Virus-induced Meningoencephalitis Complicated with Orbital Apex Syndrome: A Case Report

69歳の男性，右眼周囲の違和感，発熱を認め，その後，異常行動がみられた。入院時，JCS10，右顔面，頭頂部に小水疱，びらんを認め，右眼瞼の腫脹もあった。右眼瞳孔は散大，対光反射消失，全眼筋麻痺を認めた。髄液検査で帯状疱疹ウイルスが陽性であった。アシクロビル投与で意識清明となったが，視力は回復しなかった。眼部帯状疱疹による眼窩尖端症候群は稀であるが，ときに全眼筋麻痺や視神経炎など，重篤な合併症を伴うことがある。

Abstract

A 69-year-old male was admitted to hospital with clouded consciousness and abnormal behavior. His body temperature was 38.2℃ upon admission and he was somnolent. Herpes zoster was observed along the first division of the trigeminal nerve on the right side of the face. The right palpebra was severely swollen, and the right eye showed a dilated pupil, loss of light reflex, and total ophthalmoplegia. A spinal tap revealed pleocytosis and increased proteins, and a DNA-PCR test for varicella-zoster virus (VZV) was positive. Optic neuritis was diagnosed based on fundoscopy. Following acyclovir administration, the patient regained full consciousness and the rash was alleviated; however, visual acuity did not recover. VZV-induced meningoencephalitis complicated with orbital apex syndrome is rarely observed. We suspect that VZV initially infected the nasociliary nerve at the distal end of the first division of trigeminal nerve and spread to the adjacent optic, oculomotor, trochlear, and abducens nerves, resulting in VZV-induced meningoencephalitis complicated with orbital apex syndrome.

(Received August 5, 2013; Accepted January 22, 2014; Published September 1, 2014)