低用量ピル内服中に網膜血管炎に伴う傍中心窩黄斑虚血がみられたBehçet病疑いの1例

A case suspected of Behçet's disease manifesting retinal vasculitis with parafoveal ischemia following use of low-dosis oral contraceptive pills

要約　目的：低用量ピルの内服中に傍中心窩黄斑虚血を伴う網膜血管炎が生じ，Behçet病が疑われた症例の報告。症例：32歳女性が前日に生じた右眼の視力障害で受診した。再発性口腔内アフタと皮疹の既往があり，子宮内膜症に対し低用量のピルを18か月前から内服中であった。所見と経過：視力は右0.6，左1.5で，右眼の黄斑部に網膜白濁と小出血があった。蛍光眼底造影で両眼に網膜血管炎があった。光干渉断層計の所見と合わせ，右眼の眼底所見は網膜血管炎に伴う傍中心窩黄斑虚血と考えられた。HLA B-51が陽性で，全身の既往病変と併せて，不全型Behçet病の疑いと診断した。ピルの内服中止とプレドニゾロン内服で，眼底所見は改善し，18日後に右眼視力は1.2になった。結論：Behçet病の疑いがある症例での低用量ピルの内服が，網膜血管炎と全身の血管炎の悪化に関与した可能性がある。

Abstract.　Purpose：To report a case suspected of Behçet's disease manifesting retinal vasculitis with parafoveal ischemia following long-term peroral use of low-dosis oral contraceptive pills. Case：A 32-year-old female presented with impaired vision in the right eye since the day before. She had had recurrent oral aphtha and exanthema. She had been using low-dosis oral contraceptive pills for endometriosis for 18 months. Findings and Clinical Course：Visual acuity was 0.6 right and 1.5 left. The right eye showed retinal opacity in the macular area with hemorrhagic patches. Fluorescein angiography showed retinal vasculitis in both eyes. Findings by optical coherence tomography suggested parafoveal ischemia secondary to retinal vasculitis in the right eye. She was positive for HLA B-51. She was diagnosed with suspected Behçet's disease based on ocular and systemic manifestations. Discontinuation of pills and systemic prednisolone was followed by improved fundus findings and visual acuity of 1.2 right 18 days later. Conclusion：The present case illustrates that peroral use of low-dosis oral contraceptive pills may have induced retinal vasculitis with parafoveal ischemia as manifestation of Behçet's disease.