限局性網脈絡膜病変を合併した若年性関節リウマチの1例

A case of juvenile rheumatoid arthritis manifested isolated retinochoroidal lesions

　眼底に限局性網脈絡膜病変を伴う全身発症型若年性関節リウマチが10歳女児にみられた。右眼は乳頭部下方，左眼は血管アーケード付近に，網膜の浮腫を伴う白色の網膜下滲出性病変が存在し，網膜血管炎を伴っていた。アスピリン療法によって右眼の病変は瘢痕治癒し，左眼の病変は消失した。一般に眼科的合併症が少ないといわれている全身発症型若年性関節リウマチにおいても，網脈絡膜病変を含む眼科的検索の必要性があること，また若年性関節リウマチにおける網脈絡膜病変において，視力に障害のない症例では，アスピリンによる治療が可能であると考えた。

A 10-year-old girl was hospitalized due to recur-rent high fever of 10 days' duration. She showedarthralgia, skin eruption and spiking fever unre-sponsive to antibiotics. On the day of ophthal-mological consultation, she manifested localizedsubretinal exudate and phlebitis, suggestive ofretinochoroiditis, in both eyes. The vision was notaffected. Systemic treatment with aspirin resultedin improvements in fever and retinochoroidallesions. She was diagnosed as systemic type juve-nile rheumatoid arthritis. Rheumatic fever, col-lagen diseases and infections were ruled out. Ser-ological features were negative except for elevatederythrocyte sedimentation rate and CRP. The pres-ent case was a rare instance of localized chorior-etinitis associated with juvenile rheumatoid arthri-tis improving after oral aspirin.