原田病に類似した眼臨床所見を呈した全身悪性リンパ腫の1例

Ocular manifestations mimicking Vogt-Koyanagi-Harada disease in a case of malignant lymphoma

要約　目的：原田病に似た眼所見を呈した悪性リンパ腫の症例の報告。症例：57歳男性が両眼の視力低下で紹介され受診した。4週間前に原田病の診断でステロイドパルス治療を受けたが奏効しなかった。16か月前に脳腫瘍で摘出手術を受けていた。所見：矯正視力は右0.06，左0.2で，蛍光眼底造影により網膜色素上皮からの造影剤漏出と貯留があった。光干渉断層計で漿液性網膜剥離の所見があった。トリアムシノロン後部テノン嚢下注射とシクロスポリン投与で視力が改善したが，眼内炎は遷延した。初診から2週間後に脳腫瘍が悪性リンパ腫であったことが判明した。その3週間後に尿路感染症から全身状態が悪化し，肝脾腫など悪性リンパ腫の腫瘍崩壊を示す所見が生じ，初診から7週間後に不帰の転帰をとった。結論：本症例は悪性リンパ腫により原田病に類似した所見を呈したと解釈される。

Abstract.　Purpose：To report a case of malignant lymphoma who showed ocular symptoms mimicking Vogt-Koyanagi-Harada（VKH）disease. Case：A 57-year-old male was referred for impaired visual acuity in both eyes. He had been diagnosed with VKH disease 4 weeks before. Pulse therapy with systemic corticosteroid was futile. He had received surgery for brain tumor 16 months before. Findings：Corrected visual acuity was 0.06 right and 0.2 left. Fluorescein angiography showed leakage and pooling of dye through the retinal pigment epithelium. Optical coherence tomography showed serous detachment. The findings were compatible with the diagnosis of VKH disease. Subtenon injection of triamcinolone acetonide and systemic cyclosporine resulted in improved visual acuity and persistent intraocular inflammation. It then became apparent that the brain tumor was malignant lymphoma. He started to show signs suggestive of tumor necrosis and died 7 weeks after his initial visit. Conclusion：This case illustrates that malignant lymphoma may masquerade as VKH disease and that due attention is needed to this possibility.