急性リンパ性白血病の眼内浸潤により前房蓄膿とともに高眼圧を呈した1例

A case of ocular hypertension with hypopyon by ocular infiltration of acute lymphocytic leukemia

要約　目的：急性白血病増悪期に発症した前房蓄膿を伴うぶどう膜炎に対し，病理学的検索後，急性リンパ性白血病（ALL）の眼内浸潤と診断し，放射線療法によって寛解した1例を報告する。

症例：ALLに対する造血幹細胞移植後，中枢神経（CNS）浸潤再発により抗体療法，抗がん剤の髄液注射が行われていた57歳の女性。左眼は視神経炎により1年前に失明状態であり，当科で経過観察を行っていた。CNS浸潤再発に対して加療期間中に右視力低下を自覚し，当科受診となった。

所見：受診時視力は右（0.9），左手動弁（矯正不能）であった。眼圧は右30mmHg，左9mmHgであった。軽度の前房蓄膿を認めたが，眼底はほぼ正常であった。右高眼圧に対し緑内障点眼薬や炭酸脱水酵素阻害薬の内服でも眼圧は下降せず，ベタメタゾンリン酸エステルナトリウム点眼も無効で前房蓄膿は増強した。右前房穿刺にて採取した検体の病理学的検査および細胞表面抗原検査により，ALLの眼内浸潤と診断された。診断後すぐに放射線療法を開始したところ，数日後には浸潤細胞は消退し，眼圧も正常化した。

結論：ALLの眼内浸潤により前房蓄膿とともに高眼圧を呈したぶどう膜炎の症例を経験し，診断に至る過程で病理学的検査および細胞表面抗原検査が有用であった。放射線照射により速やかに症状は改善した。

Abstract　Purpose：To report a case of uveitis with hypopyon developed ocular hypertension during the exacerbation stage of acute leukemia that was diagnosed as intraocular infiltration of acute lymphocytic leukemia（ALL）by pathological examination, and remitted with radiotherapy.

Case：A 57-year-old woman was treated with antibody therapy and cerebrospinal fluid injections of anticancer drugs due to a recurrence of acute lymphoblastic leukemia（ALL）that had invaded the central nervous system（CNS）. She had become blind in her left eye one year ago due to optic neuritis, and was being followed up at our hospital. She visited our hospital because she noticed a decrease in her right vision during treatment for a recurrence of CNS invasion.

Result：The best corrected visual acuity was 0.9 for the right eye and HM for the left eye. Intraocular pressure was 30 mmHg for the right eye and 9 mmHg for the left eye. Mild hypopyon was observed for the right eye, but the fundus was almost normal. Intraocular pressure（IOP）did not decrease even with glaucoma eye drops and oral administration of carbonic anhydrase inhibitors for high IOP in the right eye, and the hypopyon increased despite treatment with betamethasone sodium phosphate eye drops. Intraocular infiltration of ALL was diagnosed based on pathological examination of a specimen obtained through a right anterior chamber puncture and cell surface antigen test. Radiation therapy was started immediately after diagnosis, and within a few days, the infiltrating cells disappeared and the IOP normalized.

Conclusion：We experienced a case of uveitis in which intraocular infiltration of ALL presented with hypopyon and elevated IOP, and pathological examinations and cell surface antigen test were useful in the process of reaching the diagnosis. Symptoms quickly improved after radiation exposure.