視神経網膜炎を伴った猫ひっかき病の1例

Neuroretinitis in a case of cat scratch disease

要約　目的：視神経網膜炎を併発した猫ひっかき病の1例の報告。

症例：40歳女性が10日前からの左眼の視力低下で受診した。4週間前から発熱と頭痛があった。高血圧と糖尿病があり，加療中であった。

所見と経過：矯正視力は右1.2，左0.05で，左眼に乳頭の発赤腫脹があった。光干渉断層計で左眼の黄斑部に漿液性剝離があった。蛍光眼底造影で両眼の乳頭に色素漏出があった。問診で数頭の猫を飼育していることが判明した。血液検査でBartonella henselaeに対する抗体価が陽性で，猫ひっかき病による視神経網膜炎と診断した。トリアムシノロンのテノン囊下注射とアジスロマイシン内服を行い，乳頭腫脹と網膜剝離は軽快し，6か月後の最終視力として左右眼とも1.0が得られた。

結論：本症例の視神経網膜炎としての診断では，問診が重要な役割を果たした。

Abstract　Purpose: To report optic neuroretinitis in a case of cat scratch disease.

Case: A 40-year-old woman presented with impaired vision in her left eye since 10 days before. She had had fever and headache since one month before. She had been receiving treatment for diabetes and systemic hypertension.

Findings and Clinical Course: Corrected visual acuity was 1.2 right and 0.05 left. The left eye showed hyperemia and swelling of optic disc. Optical coherence tomography showed serous retinal detachment in the central fundus area in the left eye. Fluorescein angiography showed dye leakage in the disc in both eyes. Further inquiry showed that she was living with several cats at home. Her systemic blood was positive for antibody to Bartonellae henselae, leading to the diagnosis of neuroretinitis as manifestation of cat scratch disease. She was treated by subtenon injection of triamcinolone and peroral azithromycin, followed by cure of disc swelling and retinal detachment. She showed visual acuity of 1.0 in either eye 6 months later.

Conclusion: This case illustrates that detailed history taking may give a clue to the diagnosis of cat scratch disease.