外転神経麻痺，及び視野障害を呈した蝶形骨洞原発アスペルギルス症の1例—特に抗真菌薬療法の重要性について

Sphenoid Sinus Aspergiilosis Presenting Abducens Nerve Palsy and Visual Field Impairment;Acase report

I．はじめに

　近年抗生物質，抗癌剤，副腎皮質ステロイド等の頻用に伴い，副鼻腔真菌症の報告例は耳鼻科領域で増えてきている．しかし，蝶形骨洞原発例はわれわれが検索しえた限りでは，今日までに33例の報告があるのみで，極めて稀と思われる^2-32）．また，神経症状を呈した症例は，そのうちの16例にすぎない^{346,10,13,16,21,2,32）}．われわれは，外転神経麻痺と視野欠損を呈した蝶形骨洞原発真菌症の1例を治療する機会を得たので，若干の文献的考察を加え報告する．

A case of sphenoid sinus aspergillosis presenting abducens nerve palsy and visual field impairment is re-ported. A 73-year-old woman visited our hospital with the complaint of head heaviness on the 27th of March, 1989. Although results of neurological examinations were normal, craniogram revealed the destruction of the clivus, and CT scan and MRI showed a mass le-sion, which was thought to he a mucocele in the sphe-noid sinus. On the 1st of September, she developed right abducens nerve palsy and visual field impairment. MRI performed on the same day showed an enlarge-ment of the mass lesion in the spheniod sinus.In order to decompress the involved cranial nerves, her sphenoid sinus was explored on the 22nd of September. The sphenoid sinus was filled with purulent fluid and yellowish mass. Histopathological examina-tion revealed colonies of aspergillus fumigatus. Fulco-nazole, a new antifungal drug, was given for 34 days postoperatively. The right abducens nerve palsy and the visual field impairment gradually improved along with a reduction of the mass lesion in her sphenoid sinus.

Sphenoid sinus aspergillosis is a rare disease. Its di-agnosis is difficult. However, MRI can show a specificlow signal intensity in T2-weighted image. Also in our case, MRI on the first admission showed a definite low signal intensity in some parts of the lesion, which exhi-bited a high intensity later on during the second admis-sion, probably due to a qualitative change.

To our knowledge, only 33 such cases have been pre-viously reported. Intracranial involvement occasionally occurs in this disease. In its early stage, cranial nerve palsies are caused by nerve compression or invasion by this disease. This is because these nerves run along the cavernous sinus. Meningitis or vasculitis of the internal carotid artery also occurs in the advanced stage of this disease. Six patients were reported to have died of in-tracranial involvement. Postoperatively, such invasive type of sphenoid sinus aspergillosis should be treated aggressively with new antifungal drugs, such as fluco-nazole, or itraconazole.