ループス腎炎に合併した多発性後極部網膜色素上皮症の1例

Multifocal posterior pigment epitheliopathy in a case of lupus nephritis

　ループス腎炎の経過中に，両眼に多発性後極部網膜色素上皮症（MPPE）を生じた1例を経験した。患者は54歳の女性で，中心性漿液性網脈絡膜症様所見で発症し，3年にわたって網膜色素上皮障害が再発した。腎機能障害，高血圧の悪化の時期に両眼の眼底後極部にドーナツ様滲出斑を伴う扁平な網膜剥離がみられ，螢光眼底所見で多発性の漏出点がみられた。これらの所見からMPPEと診断し，両眼の漏出点に対してレーザー光凝固を行った。発症機序として，ループス腎炎による腎障害が網膜色素上皮障害の大きな原因と考えられたが，その他にも多くの因子が作用してMPPEが発症したものと考えられ，続発性のMPPEといえる症例であった。

We diagnosed a 54-year-old female as central serous retinopathy in the left eye and successfully treated her by photocoagulation 3 years before. She had been suffering from systemic lupus erythematosus and been under systemic corticosteroid since the age of 46 years. Three years later, she developed severe impairment of retinal pigment epithelium in the posterior fundus in both eyes along with exacerbation of renal function and hypertension. Fluorescein angiography showed numerous sites of dye leakage from the choroid. She was diagnosed as multifocal posterior pigment epitheliopathy (MPPE) and was treated by photocoagulation. The onset of MPPE appeared to be associated with impairment of retinal pigment epithelium due to chronic renal failure by lupus nephritis, systemic hypertension and high-dose cortico-steroid administration