一時失明状態になった両眼性真菌性鼻性視神経症の1例

Rhinogenous optic neuropathy with temporary bilateral blindness in a case of mycotic sinusitis

要約　目的：真菌性鼻性視神経症で一時失明状態となったが，早期治療で改善した1例の報告。症例：79歳男性，急激な両眼視力低下を主訴に受診した。所見：当科初診3か月前に頭痛があり，その後両眼の視力低下を生じた。画像所見より副鼻腔真菌症を疑い，初診当日に耳鼻科へ紹介した。両眼性鼻性視神経症と診断され，翌日に内視鏡下副鼻腔手術を施行し，アスペルギルス症と診断された。手術翌日に両眼光覚（−）となり，抗真菌薬・副腎皮質ステロイドの内服を開始し，中心暗点は残存したが，視力・視野は改善した。後に肥厚性硬膜炎が発見されたが，治療前から存在した可能性は否定できていない。結論：早期治療にて真菌性鼻性視神経症が改善した。

Abstract.　Purpose：To report a case of rhinogenous optic neuropathy with temporary bilateral blindness presumably secondary to mycotic sphenoidal sinusitis that responded to surgery and medication. Case：A 79-year-old male presented with sudden bilateral visual loss since 4 days before. He had had headache 3 months before. Findings：Corrected visual acuity was 0.09 right and 0.03 left. Both eyes showed swelling of optic disc. Perimetry showed large central scotoma involving the blind spot. Hematological studies showed uncontrolled diabetes mellitus. Computed tomography showed signs of mycosis in the left sphenoidal sinus, leading to endoscopic surgery the following day and to diagnosis of aspergillosis. Both eyes became blind 3 days after surgery. Treatment with systemic antifungal agents and corticosteroid was followed by improved visual acuity to 0.1 in either eye 3 months later. Eight months after his initial visit, he developed facial, abducens and auditory palsy and was diagnosed with hypertrophic pachymeningitis. Conclusion：Early treatment was effective in the present case of optic neuropathy secondary to mycotic sphnoidal sinusitis.