梅毒性ぶどう膜炎の2例

Two cases of syphilitic uveitis

要約　目的：黄斑部に脈絡膜新生血管（CNV）を生じた梅毒性ぶどう膜炎，および両眼性に前房蓄膿を生じた梅毒性ぶどう膜炎の報告。

症例：［症例1］54歳，男性。202X−1年，近医で右眼前部ぶどう膜炎の加療歴がある。202X年7月，左視力低下にて横浜市立大学附属病院（当院）を受診した。初診時視力は右（1.2），左（0.2），左眼黄斑部に斑状の白色病巣，OCTにて黄斑部の網膜下高輝度病巣（SHRM）および網膜内液がみられ，インドシアニングリーン蛍光眼底造影にて病巣部の低蛍光，ならびにフルオレセイン蛍光眼底造影（FA）にて同部位のstainingが認められたことから，CNVの存在が示唆された。血清梅毒RPR定量128倍，TPAb定量40,960倍であったため活動性梅毒と診断され，駆梅療法を施行した。SHRMが拡大したため，トリアムシノロンアセトニド後部テノン囊下注射およびアフリベルセプト硝子体内注射を行った。現在まで滲出性変化はなく，CNVの再発もない。

［症例2］51歳，男性。202X年8月，両眼前部ぶどう膜炎にて加療していた。10月に左霧視が出現し当院を受診した。初診時視力は右（1.2），左（1.0），左眼に前房蓄膿を伴う前眼部炎症があり，FAにて網膜血管からの蛍光漏出がみられた。1週間後，右眼にも前房蓄膿が出現した。血清梅毒RPR定量256倍，TPAb定量81,920倍であったため駆梅療法を施行した。眼炎症はステロイド点眼にて消炎した。

結論：ぶどう膜炎患者を診察する際には梅毒の可能性を常に考える必要がある。

Abstract　Purpose：Here we present two cases of syphilitic uveitis, one involving choroidal neovascularization（CNV）in the macular region and the other involving bilateral hypopyon.

Case：（Case 1）In 202X-1, a 54-year-old man received treatment at a community clinic for anterior uveitis in the right eye. However, in July 202X, his left visual acuity significantly decreased, prompting a referral to our hospital. In the initial examination, his best-corrected visual acuity（BCVA）was 1.2 in the right eye and 0.2 in the left eye, with mottoled white exudative lesions observed in the macular region of the left eye. Optical coherence tomography revealed subretinal hyperreflective material（SHRM）and intraretinal fluid（IRF）. Indocyanine green angiography showed hypocyanine consistent with the lesions, and staining in the same area was observed on fluorescein angiography（FA）, suggesting the presence of CNV. The patient's high serological non-treponemal（PRP：128 times）and treponemal-specific（TPAb：40960 times）titers led to a diagnosis of syphilis, for which he was treated with oral amoxicillin hydrate and probenecid. Due to enlarged SHRM, the administration of sub-Tenon's triamcinolone acetonide and intravitreal aflibercept injections were performed, which eventually resulted in no exudative changes of CNV and there has been no recurrence to date.（Case 2）In August 202X, a 51-year-old man was treated at a community clinic for bilateral anterior uveitis. In October, he was referred to our hospital with blurred vision in his left eye. In the initial examination, his BCVA was 1.2 in the right eye and 1.0 in the left eye. In the left eye, anterior chamber inflammation with serous hypopyon was observed. Fluorescent leakage from retinal vessels in the left eye was detected using FA. One week later, serous hypopyon was also observed in the right eye. The patient's serum non-treponemal（RPR：256 times）and treponemal-specific（TPAb：81920 times）titers were high, and he was diagnosed with syphilis. He was also treated with oral amoxicillin hydrate and probenecid, and ocular inflammation resolved of topical corticosteroid use.

Conclusion：The possibility of syphilis should always be considered in cases of uveitis.