鼻性視神経症との鑑別に苦慮したリネゾリドによる視神経症の1例

A case of linezolid-associated optic neuropathy simulating rhinogenic disorder

要約　目的：抗菌薬リネゾリドによると思われる両眼性視神経症の症例の報告。症例：68歳男性が，5か月前からの両眼の視力障害で受診した。糖尿病，関節リウマチ，心筋梗塞の既往があった。所見と経過：矯正視力は右0.3，左0.4で，前眼部，中間透光体，眼底には異常がなかった。副鼻腔炎の所見があり，抗菌薬を投与した。1か月後に視力は左右とも0.05になり，中心暗点が両眼に生じた。既往歴を再聴取し，膝の人工関節置換術後のMRSA感染に対してリネゾリド投与を2年前から受けていたことが判明した。リネゾリド投与を中止し，6週後の視力が左右とも1.5に回復し，中心暗点が消失した。結論：リネゾリドの長期投与で視神経障害が生じることがある。

Abstract.　Purpose：To report a case of bilateral optic neuropathy following prolonged systemic treatment with linezolid. Case：A 68-year-old male presented with bilateral impairment of vision since 5 months before. He had been suffering from diabetes mellitus, rheumatic arthritis and cardiac infarction. Findings and Clinical Course：Corrected visual acuity was 0.3 right and 0.4 left. Both eyes were apparently normal. Computed tomography showed sphenoidal, ethmoidal and maxillary sinusitis, leading to prescription of antibacterial drugs. Visual acuity decreased to 0.05 with central scotoma in either eye one month later. The patient disclosed to have been receiving systemic linezolid since 2 years before for infected right knee. Discontinuation of linezolid was followed by improved visual acuity of 1.5 each 6 weeks later. Conclusion：This case illustrates that toxic optic neuropathy may develop after prolonged systemic use of linezolid.