高校入試直前に発症したネコひっかき病の1例

Cat scratch disease manifesting as neuroretinitis in a boy just before entrance examination for senior high school

要約　目的：高校入試直前にネコひっかき病が発症した症例の報告。症例：15歳男性が発熱に続き左眼視力低下を自覚した。解熱後も眼症状が持続したため近医を受診し，乳頭浮腫を指摘され当科紹介となった。5日後に高校入試を控えていた。初診時の矯正視力は両眼1.0で，両眼視神経乳頭の発赤腫脹，左眼底の漿液性剝離および白色滲出斑などの所見に加え，頸部リンパ節腫脹を認めた。ネコの飼育歴があり，初診時の血液検体からBartonella henselae抗体価の上昇がみられたことからネコひっかき病による視神経網膜炎と診断した。抗菌薬および副腎皮質ステロイド薬内服を行った。治療開始後，計3回の受験があり，すべてマスク着用で個室にて行われた。発症から7か月後の現在，両眼矯正視力は1.5で，視神経網膜炎の再発はない。結論：発症後早期の抗体価検索と治療開始で，ネコひっかき病の重症化を防ぐことができ，加えて各受験場の適切な対応により高校入試を無事完遂させることができた。

Abstract.　Purpose：To report a case of neuroretinitis as manifestation of cat scratch disease. Case：A 15-year-old boy presented with impaired vision in both eyes since 2 weeks before. He had had fever 6 weeks before. His family had been keeping a dog and a cat. An entrance examination for a senior high school was scheduled 5 days later. Findings：Corrected visual acuity was 1.0 in either eye. The left eye felt pain during eye movement. Both eyes showed swollen and hyperemic disc. The left eye showed detached papillomacular area with exudates. Fluorescein angiography showed dye leakage from the disc in both eyes. Lymph node swelling was present in the neck. The blood was positive for anti-Bartonella henselae IgG and IgM antibodies. He was diagnosed with cat scratch disease and was treated by systemic antibiotics and corticosteroid. He took the entrance examination in a private room. His ocular findings and visual acuity gradually improved to 1.5 in either eye. He has been doing for 7 months until present. Conclusion：This case illustrates the need of early diagnosis by serological tests with prompt treatment in cat scratch disease manifesting as neueroretinitis.