Birdshot retinochoroidopathy様の眼底所見を呈したHeerfordt症候群の1例

A case of Heerfordt's syndrome manifested birdshot retinochoroidopathy

　顔面神経麻痺，耳下腺腫脹，ぶどう膜炎の3症状を示すサルコイドーシスの一亜型であるHeerfordt症候群と診断された57歳女性を報告する．

　眼底所見において，サルコイドーシスに特徴的なsnowball opacity，網脈絡膜炎の所見に加えて，多数の境界比較的鮮明な小円形黄白色斑を認めた．この黄白色斑は，最近報告されたbirdshot retino-choroidopathyの眼底所見と酷似しており，サルコイドーシスにおいてもこのような眼底所見を呈することは少なくないと考えられた．

A 57-year-old female presented with bilateral blurred vision of 2 months' duration. During the foregoing 4 weeks, she suffered from fever, bilat-eral facial nerve palsy, and swelling of both parotid glands. We detected uveitis with vitreous opacity, peripheral anterior synechia and small nodules over the trabeculum in both eyes.

Bilateral hilar lymphadenopathy was shown on chest x-ray. The activity of serum angiotensin converting enzyme was increased. Transbronchial lung biopsy (TBLB) confirmed the diagnosis of sarcoidosis.

The fundus changes simulated birdshot retino-choroidopathy. In the left eye, small cream-colored spots were scattered over the midperipheral fundus, in addition to snowball opacity, disc edema, and retinal vascular leakage. Similar depigmented spots, though fewer in number, were present in the right fundus. In fluorescein angiography, these spots showed hyperfluorescence during the early phase to persist, without notable changes, through the late phase.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(11) : 1273-1277, 1988