抗結核療法が奏効した網膜静脈周囲炎の1例

A case of retinal periphlebitis with favorable response to antituberculosis therapy

　31歳男性が肺結核と診断され，エタンブトール投与前の検査として眼科を受診した。ツベルクリン反応は強陽性で，結核性胸膜炎が併発していた。矯正視力は右1.5，左0.7であり，両眼に網膜静脈周囲炎，左眼に血栓性静脈炎による黄斑浮腫があった。全身状態を考慮してステロイド薬は用いず，3剤併用による抗結核療法のみで治療した。左眼視力は3週問後に0.2に低下したが，6か月後に網膜静脈周囲炎は寛解し，左眼視力は1.5に改善した。経過中に網膜新生血管が発生したために網膜光凝固を行った。結核性網膜静脈周囲炎へのステロイド薬の全身投与は，抗結核療法への反応をみてから考慮すべきであることを本症例は示している。

A 31-year-old male was diagnosed with pulmonary tuberculosis. He was referred to us before start of systemic ethambutol. Skin test for purified protein derivative (PPD) was strongly positive. He had also tuberculous pleurisy. His corrected visual acuity was 1.5 right and 0.7 left. Funduscopy showed retinal periphlebitis in both eyes and macular edema secondary to thrombotic phlebitis in the left. He was treated with three antituberculous drugs. Systemic corticosteroid was not used due to systemic conditions. After his left visual acuity decreased to 0.2 3 weeks later, retinal periphlebitis resolved after 6 months with recovery of left visual acuity to 1.5. Fundus photocoagulation was performed for retinal neovascularization. This case illustrates that tuberculous retinal periphlebitis may cure by antituberculous medication alone without recourse to systemic corticosteroid.