COVID-19により診断と治療開始が遅れたVogt-小柳-原田病の1例

A case of Vogt-Koyanagi-Harada disease which diagnosis and start of therapy were delayed because of COVID-19

要約　目的：新型コロナウイルス感染症（COVID-19）により診断と治療開始が遅れたVogt-小柳-原田病（VKH）の1例を経験したので報告する。

症例：患者は59歳，男性。両眼の視力低下と頭痛を自覚し近医を受診した。原因不明のぶどう膜炎と診断され，点眼液が処方された。その後COVID-19陽性が判明し，2週間の自宅隔離となった。隔離が解除になり，前医を再診したところ悪化していたのでプレドニゾロン20mg/日の内服を追加処方され，獨協医科大学埼玉医療センター眼科に紹介され受診となった。初診時視力は右0.2（0.5），左0.3（0.5）で，両眼ともほぼ全周に水晶体と虹彩癒着があり，右眼底に脈絡膜剝離，両眼に脈絡膜肥厚を生じていた。VKHと診断し，ステロイドパルス療法を行った。当初は治療によく反応したが，治療開始4か月後からプレドニゾロン内服を時折休薬していた。治療開始5か月後に前房内炎症が再燃した。治療開始10か月後の視力は左右とも（1.2）であり，夕焼け状眼底を呈している。

考按：COVID-19陽性が判明し隔離が必要となり治療開始が遅れたこと，不適切なプレドニゾロン内服などが，再燃に結びついた可能性がある。

Abstract　Purpose：To report a case of Vogt-Koyanagi-Harada disease that was diagnosed and treated late because of COVID-19.

Case：A 59-year-old man had medical check at a previous hospital because of loss of vision in both eyes and headache. He was diagnosed with unidentified uveitis and prescribed betamethasone sodium phosphate Ophthalmic solution. He became infected with COVID-19 without symptoms and had to stay home for two weeks. His eye condition became worse after staying home, and taking prednisolone at 20 mg/day, and he was referred to our hospital. The best-corrected visual acuity was 0.5 with lens-iris synechia all around and thickened choroids in both eyes at initial visit. He was treated with steroid pulse therapy after emergency admission. He had not taken prednisolone regularly since four months after his initial visit, and inflammation had recurred in the anterior chamber. He had sunset glow fundi in his both eyes, and the best-corrected visual acuity was 1.2 in both eyes, respectively, at 10 months after initial visit.

Conclusion：A delay of treatment due to COVID-19 and irregular predonisolone treatment may cause the recurrence of Vogt-Koyanagi-Harada disease.