高度の閉塞性血管炎を合併した樹氷状血管炎の1例

A case of frosted branch angiitis associated with severe occlusive vasculopathy

要約　目的：両眼に閉塞性血管炎を伴う樹氷状血管炎の症例の報告。症例：60歳男性。視力低下が3日の差で両眼に突発し，発症から5日後に受診した。所見：矯正視力は右0.03，左0.08であり，両眼に前部ぶどう膜炎の所見があり，軽度の硝子体混濁，乳頭の発赤，出血斑の散在を伴う動脈の白鞘化があった。フルオレセイン蛍光眼底造影で，動静脈からの蛍光漏出と部分的な血管閉塞があった。前房水からウイルスは検出されなかった。アシクロビル点滴，副腎皮質ステロイドの内服とパルス療法を行い，病変が鎮静化し，初診から7か月後に両眼とも0.6の視力を得た。結論：本症例は急性網膜壊死に似た所見を呈したが，樹氷状血管炎であったと推定される。炎症の鎮静化にステロイドパルス療法が有効であった。

Abstract.　Purpose：To report a case of frosted branch angiitis associated with occlusive vasculopathy. Case：A 60-year-old male noted sudden blurring in his right eye followed by similar event in his left 3 days later. He was seen by us 5 days after onset. Findings：His corrected visual acuity was 0.03 right and 0.08 left. Both eyes showed findings of anterior uveitis, vitreous opacity, hyperemia of optic disc, hemorrhagic patches and sheathing of retinal arteries. Fluorescein angiography showed dye leakage from retinal arteries and veins with vascular occlusion in the periphery. No virus was detected in the aqueous humor. He was treated by intravenous acyclovir and corticosteroid through peroral route and as pulsed therapy. Findings improved resulting in visual acuity of 0.6 in either eye 7 months after onset. Conclusion：This case was diagnosed with frosted angiitis after ruling out acute retinal necrosis. Systemic corticosteroid was effective in inducing remission and improvement of visual acuity.