後部強膜炎を合併した再発性多発軟骨炎の1例

Posterior scleritis in a case of relapsing polychondritis

要約　目的：再発性多発軟骨炎に後部強膜炎が併発した症例の報告。症例：73歳女性が急激な右眼視力低下と眼球運動痛で受診した。5年前に両側の耳介軟骨炎で再発性多発軟骨炎と診断され，プレドニゾロンと免疫抑制剤ミゾリビンで寛解し，維持療法中であった。3年前に右眼の上強膜炎が反復した。矯正視力は右0.3，左1.2であり，右眼に虹彩毛様体炎，漿液性網膜剝離，脈絡膜皺襞があり，画像検査で眼球後壁の肥厚と視神経周囲炎があった。後部強膜炎と診断し，プレドニゾロンを増量してミゾリビンは継続した。発症から5日後に眼内所見は軽快し，以後10か月後の現在まで再発はない。結論：再発性多発軟骨炎では加療中であっても，晩期合併症として後部強膜炎が生じることがあるので注意が必要である。

Abstract.　Purpose：To report a case of relapsing polychondritis with posterior scleritis as a late complication. Case：A 73-year-old female presented with acute visual impairment in her right eye and pain during eye movement. She had had bilateral auricular chondritis and been diagnosed with polychondritis 5 years before. She had been receiving prednisolone and immunosuppressant ever since. She had developed recurrent episcleritis 3 years before. Her visual acuity was 0.3 right and 1.2 left. The right eye showed signs of iridocyclitis, serous retinal detachment, and choroidal folds. Diagnostic imaging showed thickening of posterior sclera and optic perineuritis. Under the diagnosis of posterior scleritis, she was treated with increased doses of prednisolone. Intraocular findings improved on day 5 of treatment. There has been no recurrence during 10 months until present. Conclusion：This case illustrates that posterior scleritis may develop as a late complication of relapsing polychondritis.