クリプトコッカス視神経炎の1例

A case of cryptococcal optic neuritis

要約　目的：クリプトコッカス視神経炎の1症例の報告。

症例：35歳，男性。頭痛・食欲不振などの全身症状および変視症を認めた。

所見：矯正視力右0.6左0.8。感冒様症状・項部痛・視神経乳頭腫脹および漿液性網膜剝離（SRD）といった原田病に類似する所見でありながら，SRDの光干渉断層計での所見の違い，また前房内炎症を認めないことから原田病とは異なると考えられた。髄液検査で細胞数・蛋白高値，採血でクリプトネオ抗体高値を認めクリプトコッカス髄膜炎と診断された。

結論：本症例は臨床所見が原田病に類似したが，クリプトコッカス髄膜炎であった。

Abstract　Purpose: To report a case of cryptococcal meningitis with involvement of optic nerve.

Case: A 35-year-old male presented with metamorphopsia, headache and poor appetite. Corrected visual acuity was 0.6 right and 0.8 left. He showed symptoms simulating Vogt-Koyanagi-Harada（VKH）disease including stiff neck, swelling of optic disc, and serous retinal detachment. Other diagnostic possibilities were shown by atypical findings of serous retinal detachment by optical coherence tomography（OCT）and by the absence of signs of inflammation in the anterior segment. Cerebrospinal liquid showed high protein level and increased cells, leading to the diagnosis of cryptococcal meningitis.

Conclusion: The present case showed clinical features simulating VKH disease but proved to be cryptococcal meningitis with ocular involvement.