ステロイドの全身投与が著効した小児の急性涙囊炎の1例

A case of acute dacryocystitis in a child with significant response to systemic administration of corticosteroids

要約　目的：小児の急性涙囊炎の原因としてアレルギー性鼻炎が考えられ，抗菌薬と副腎皮質ステロイドの全身投与が著効した症例を経験した報告。

症例：6歳，男児。左涙囊部の腫脹が出現し，翌日前医で急性涙囊炎と診断された。抗菌薬の点眼，軟膏，内服薬が処方され，同日当科へ紹介となった。初診時，左涙囊部の発赤，腫脹，熱感があり，急性涙囊炎と考え，前医の処方を継続とした。4日後，涙囊炎は増悪しており，CTで左下鼻道，骨性鼻涙管に含気がなく，耳鼻咽喉科で施行された鼻咽腔内視鏡で左下鼻道の粘膜腫脹を認めた。アレルギー性鼻炎により鼻粘膜が腫脹し鼻涙管開口部を閉鎖し急性涙囊炎が生じたと考えられた。抗菌薬と副腎皮質ステロイドの全身投与を開始したところ，2日後，所見は速やかに改善し，同治療は3日間で終了した。

結論：小児の急性涙囊炎の原因としてアレルギー性鼻炎が考えられる場合は，副腎皮質ステロイドの全身投与を考慮に入れてもよいと考えられた。

Abstract　Purpose：We report a case of acute dacryocystitis in a child. This disorder was thought to have been caused by allergic rhinitis, and was significantly improved by systemic administration of antibiotics and corticosteroids.

Case：The patient was a six-year-old boy with swelling in the left lacrimal sac. The day after swelling was observed, he was diagnosed with acute dacryocystitis by a previous doctor. Eye drops, ointments, and oral antibiotics were prescribed, and he was referred to our department on the same day. At the first visit, redness, swelling, and heat sensation was observed in the left lacrimal sac. Hence, we continued the prescription from the previous doctor considering it as acute dacryocystitis. Four days later, the dacryocystitis worsened, and CT showed no air in the left inferior meatus of the nasal cavity and bony nasolacrimal duct. Nasopharyngoscopy performed by an otolaryngologist revealed mucosal swelling in the left inferior meatus. It was thought that allergic rhinitis caused nasal mucosal swelling and closed the nasolacrimal duct opening, resulting in acute dacryocystitis. Systemic administration of antibiotics and corticosteroids was started. Two days later, the patient's symptoms improved immediately, and treatment was completed in 3 days.

Conclusion：In case allergic rhinitis is considered as a cause of acute dacryocystitis in children, systemic administration of corticosteroids may be considered.