後極部網膜より発症した急性網膜壊死の1例

Posterior fundus lesion masqueraded in a case with acute retinal necrosis

　発病初期の網膜病変が黄斑部を含む後極部にみられた片眼性の急性網膜壊死の1例を経験した。症例は43歳の健康女性で，ステロイドやアシクロビルの治療に抵抗して硝子体混濁が増強し，発病から40日後に網膜全剥離に陥った。単純ヘルペスウイルス（HSV）の抗体価がペア血清で2倍，前房水においては8倍の抗体価の変動がみられた。水痘帯状疱疹ウイルス（VZV）および他のウイルスの抗体価に変動はみられなかった。病因としてHSVの関与が考えられた。

We observed a highterto healthy 43-year-old female who developed ocular pain and acute visual failure in her left eye the day before. We detected yellowish-white opacity and blotch hemorrhages temporal to the macula in the affected eye. Vitre-ous opacity and aqueous flare were also present. The peripheral retina was free of pathological changes.

In spite of treatment with systemic corticosteroid and acyclovir, the fundus lesion developed into typical findings of acute retinal necrosis and into total retinal detachment 40 days later.

Immunoglobulin G titers for varicella zoster virus and cytomegalovirus remained stationary throughout the course of the disease. The titer for herpes simplex virus type I (HSV- I) was ini-tially 160 in the serum and 20 in the aqueous, which increased to 320 and 160 respectively later. The finding suggested that HSV- I might be involved in the pathogenesis in this patient.