春季カタル様病変を呈したIgG4関連眼疾患の1例

A case of IgG4-related ophthalmic disease with vernal catarrh like lesion

要約　目的：眼瞼腫瘤を生じたIgG4関連眼疾患の1症例の報告。

症例：52歳男性が，抗アレルギー点眼薬で結膜炎が改善せず受診。両側上下眼瞼結膜は充血し，春季カタル様の石垣状増殖組織があった。結膜の塗抹顕鏡で好酸球と好中球を検出し，増殖組織の病理検査では慢性結膜炎で，春季カタルに矛盾のない結果であった。免疫抑制薬とステロイドの点眼薬を追加し，結膜炎は改善した。その後，両側下眼瞼結膜の肥厚と眼瞼腫瘤を生じて再診した。点眼薬再開後も両側下眼瞼の腫瘤は改善せず，右下眼瞼の腫瘤の一部を摘出し，病理組織検査を行った。病理所見と高IgG4血症からIgG4関連眼疾患と確定診断した。ステロイド内服投与にて眼瞼腫瘤は消失した。以前採取した石垣状の眼瞼結膜増殖組織を再検査したところ，病理組織学的にIgG4関連眼疾患の診断基準を満たしていた。

結論：若年症例ではない春季カタル様の結膜増殖組織では，IgG4関連眼疾患の可能性がある。

Abstract　Purpose：To report a case of IgG4-related ophthalmic disease（IgG4-ROD）with eyelid tumor.

Case：A 52-year-old man with conjunctivitis presented to our clinic after noticing no improvement with anti-allergic eye drops. The bilateral upper and lower eyelid conjunctiva were hyperemic, and there was a cobblestone proliferative tissue resembling vernal catarrh. Conjunctival smear microscopy revealed abundant eosinophils and neutrophils and pathological examination of the proliferative tissue revealed chronic conjunctivitis, consistent with vernal catarrh. We prescribed him immunosuppressive drugs and steroid eye drops, and the conjunctivitis improved. Subsequently, the patient visited us again with thickening of the bilateral lower eyelid conjunctivae and eyelid tumor. The bilateral lower eyelid tumors did not improve on resuming treatment with eye drops, and therefore a portion of the right lower eyelid tumor was excised for histopathological examination. Based on the pathological findings and elevated serum IgG4 levels, a definite diagnosis of IgG4-ROD was made. The eyelid tumor resolved with oral steroid administration. Reexamination of the previously collected cobblestone eyelid conjunctival proliferation tissue showed that the histopathological features were consistent with the diagnostic criteria for IgG4-ROD.

Conclusion：Conjunctival proliferative tissue with a vernal catarrhal-like appearance in a non-young patient may indicate IgG4-ROD.