視神経アスペルギルス症（Aspergillosis）の1例

ASPERGILIOSIS OF THE OPTIC NERVE REPORT OF A CASE

Ｉ．はじめに

　真菌症が中枢神経系をおかすことは知られているが，孤立性に病変をもつことは少ない。また視神経など脳神経をおかすことはきわめて稀である。最近我々は，片側性眼球突出，視力障害をきたし，視神経及びその周囲に限局したアスペルギルス症を経験し，剖検する機会をえたのでここに報告する。眼窩内アスペルギルス症は文献上，現在まで31例の報告をみるが，そのほとんどが鼻腔，副鼻腔，大脳の病変を伴つており，眼窩内に限局しているのは6例のみである。これら6例はいずれも手術所見であり剖検により他に病変をみなかつたという報告はない。尚本症例は眼窩内アスペルギルス症としては本邦では最初の報告である。当症例は術前レ線上，片側視神経管の拡大をみたため視神経膠腫，あるいは髄膜腫と診断されていた。なお，眼窩内アスペルギルス症の特徴と鑑別等を当症例と文献上の報告例より考察してみたい。

Optic aspergillosis is very rare. Only 31 cases have been ever reported in the literature, of which 21 cases were accompanied with lesion in nasal sinuses. In only 6 cases, lesions were considered to be confined within the orbit, however, none of them were confirmed by autopsy. This is the first report of the optic aspergillosis that has no other lesion outside the optic nerve from the autopsy findings.

Case. A 55 year-old man, with a history of con-junctivitis 6 months prior to the admission, noticed pain in the forehead, double vision and exophthal-mos on the right side. Just before the admission, he found himself blind on the right side and papill-edema was discovered by an ophthalmologist on the same side. On admission the skull x-ray film revealed marked enlargement and destruction of the right optic canal. At the operation, the right en-larged and bulky optic nerve was encountered, which was resected as possible. Pathological report was aspergillosis of the optic nerve. 9 days after the operation, he die from hematemesis. Autopsy showed no other lesions of Aspergillus outside the optic nerve. The authors consider that Aspergillus entered from the eye and invated the optic nerve. The authors reviewed the past reports and discussed briefly, and also emphasize that, even in the case of healthy person, Aspergillus often entered into the orbit from the lesion of the eyes or nasal sinuses.