眼窩先端部症候群で発症し内頚動脈浸潤した副鼻腔真菌症の3症例

Invasive Paranasal Sinus Fungal Infection Developing Orbital Apex Syndrome and Causing Internal Carotid Artery Infiltration: Reports of 3 Cases

Ⅰ．はじめに

　近年，ステロイドや抗悪性腫瘍薬での免疫抑制状態患者の増加を背景に，深在性真菌症の発生頻度は増加してきている¹⁴⁾．なかでも浸潤型アスペルギルス症やムコール症などは，比較的稀に副鼻腔炎から，粘膜や骨を破壊し，直接眼窩内や頭蓋底に浸潤^8,12,16)することがあり，海綿静脈洞部内頚動脈浸潤から，脳梗塞や脳出血などの脳血管障害を合併することがあり，注意すべき病態である．

　今回われわれは，眼窩先端部症候群（orbital apex syndrome）にて発症し，その後比較的急速な経過で海綿静脈洞部内頚動脈浸潤を生じ，結果的に脳梗塞や出血を合併することで不幸な転帰を辿った頭蓋内真菌症の3症例を経験した．本稿では，これらの症例を呈示し，文献的考察を加え報告する．

　Fungal infection is an increasing problem in patients treated with intensive chemotherapy or immunosuppressive therapy. Of these,invasive aspergillosis or mucormycosis on rare occasions,infiltrate the internal carotid artery (ICA) by contiguous spread from an infected paranasal sinus. Here,we report three cases of ICA infiltration secondary to the fungal infections of the paranasal sinus. All cases developed orbital apex syndrome when the lesion spread to the orbital apex or cavernous sinus,and aggressive progression led to ICA invasion causing life-threatening cerebral infarction or hemorrhage. In this case report,we describe the aggressive clinical course of the fungal ICA invasion from the paranasal sinus,and then discuss the clinical feature,diagnostic methods,and current treatment of intracranial fungal infection.