脈絡膜肉芽腫を伴うサルコイドーシスの1例

Choroidal granuloma in a case of sarcoidosis

　31歳男性が4か周前からの右眼の視力低下で受診した。矯正視力は右0.05，左1.0，眼圧は右12mmHg，左13mmHgであった。右眼の角膜に豚脂様後面沈着物，前房に炎症細胞の浮遊，隅角に大きな結節があった。左眼の前眼部には異常所見はなかった。眼底所見として，右眼の黄斑部の網膜下に淡黄色の境界不鮮朋な約5乳頭径大の隆起性病変があり，左眼の黄斑部の外上方に約1乳頭径大の隆起があった。気管支からの採取物の生検を含む全身所見からサルコイドーシスと診断した。プレドニゾロンの経口投与による漸減療法で，眼底の隆起性病変は著しく縮小し1，10か月後に右眼視力は1.2に改善した。本症例は，両眼の脈絡膜肉芽腫がサルコイドーシスの初発所見であり得ることを示している。

A 31-year-old man presented with blurring of vision in his right eye since 4 months before. His corrected visual acuity was 0.05 right and 1.0 left. The intraocular pressure was 12mmHg right and 13mmHg left. The right eye showed mutton-fat keratic precipitates, cells in the anterior chamber, and a large nodule in the chamber angle. Fundus-copy showed a pale yellow choroidal granuloma in the macular area in the right eye. A similar lesion was present tem-poral to the macula in the left eye. He was diagnosed with sarcoidosis based on systemic findings including biopsy of material from the trachea. Peroral prednisolone in decreasing dosis resulted in regression of choroidal granuloma. The visual acuity in his right eye improved to 1.2 10 months later. This case illustrates that bilateral choroidal granuloma may manifest as the initial sign of sarcoidosis.