流行性耳下腺炎を伴わないがムンプスウイルスの関与が疑われた劇症角膜内皮炎の1例

A case of fulminant corneal endotheliitis without parotitis suspected of mumps virus infection

要約　目的：流行性耳下腺炎を伴わないムンプスウイルスの関与が疑われた劇症角膜内皮炎の症例の報告。症例：63歳男性。8日前に39℃の発熱があり，その翌日から左眼霧視を自覚した。初診時左＝（40cm指数弁），左眼毛様充血，角膜全体の著明な上皮浮腫，実質浮腫，Descemet膜皺襞を認めた。ムンプスウイルス抗体価の検索で，IgMが検出された。ステロイド局所投与で加療し，角膜は瘢痕を残すことなく速やかに透明化した。初診3か月後左＝（1.2），角膜内皮細胞密度は426/mm²と著しく減少した。結論：原因不明のびまん性角膜内皮炎では，耳下腺腫脹がなくてもムンプスウイルスの関与の可能性がある。

Abstract.　Purpose：To report a case of fulminant corneal endotheliitis who showed no parotitis and who was suspected of mumps virus infection. Case：A 63-year-old male presented with impaired vision in the left eye. He had had acute fever 8 days before and noticed impaired vision in the left eye the next day. Findings：Corrected visual acuity was 1.5 right and counting fingers left. The left eye showed ciliary injection, diffuse edema of corneal epithelium and stroma, and folds of Descemet membrane. The serum was tested for mumps virus antibody and showed elevated IgM titer. Topical treatment with betamethasone was followed by clearing of the cornea without scarring. Visual acuity improved to 1.2 three months later. Density of corneal endothelial cells decreased to 426/mm². Conclusion：This case illustrates that mumps virus may be involved in diffuse corneal endotheliitis of unknown origin.