ステロイド忌避傾向のアトピー性皮膚炎患者に生じた難治な角膜ヘルペスの1例 (眼科学教室 堀貞夫教授退任記念特別号)  [in Japanese] A Case of Severe Herpetic Keratitis with Atopic Dermatitis Accompanied by Steroid Phobia  [in Japanese]

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Author(s)

    • 田尻 晶子 Tajiri Akiko
    • 東京女子医科大学医学部眼科学 Department of Ophthalmology, Tokyo Women's Medical University School of Medicine
    • 高村 悦子 Takamura Etsuko
    • 東京女子医科大学医学部眼科学 Department of Ophthalmology, Tokyo Women's Medical University School of Medicine
    • 堀 貞夫 Hori Sadao
    • 東京女子医科大学医学部眼科学 Department of Ophthalmology, Tokyo Women's Medical University School of Medicine

Abstract

目的:アトピー性眼瞼炎の経過中、片眼に角膜潰瘍が出現し、難治な経過をとった症例を報告する。,症例:症例は、32歳、男性。前医にて、難治なアトピー性角結膜炎として加療され、当科を紹介初診した。初診時、両眼瞼の腫脹、紅斑、びらんを認め、細隙灯顕微鏡では、右眼の結膜充血、角膜実質の混濁、角膜中央部に、シールド潰瘍に類似した病変と、その周囲に線状に伸びる角膜びらんが認められた。びらんからは、単純ヘルペスウイルス1型が検出された。角膜ヘルペスの治療中、眼瞼炎の増悪を認めたが、ステロイド薬に対する、患者の理解を得るまで、十分なステロイド薬治療が行えず、治療が困難となった。ステロイド薬治療に対する患者の同意を得て、アトピー性眼瞼炎の治療を行うことにより、難治な経過ではあったが、眼瞼および角結膜所見が改善した。,結論:アトピー性皮膚炎患者では、アトピー性角結膜炎により臨床像が修飾され、上皮型角膜ヘルペスの診断が難しい。したがって、アトピー性角結膜炎のみならず、角膜ヘルペスも念頭にいれた治療を行う必要があり、さらに、アトピー性眼瞼炎に対する治療も考慮する必要があると思われた。治療に際しては、アトピー性皮膚炎患者特有のステロイドへの不信感との関わりも重要であると思われた。,

Purpose: To report a severe case of herpetic keratitis in a patient with atopic blepharitis who presented with a persistent unilateral corneal ulcer.,Case report: The patient was a 32-year-old man with atopic blepharitis who presented with a persistent unilateral corneal ulcer. He had been diagnosed with and treated for atopic keratoconjunctivitis (AKC) at a local eye clinic without any improvement and was therefore referred to our institution. At the initial visit, swelling, erythema, and erosion were observed on both eyelids. Slit-lamp examination revealed conjunctival hyperemia, central corneal stromal opacity, and shield ulcer. Linear erosions were observed around the ulcer. Herpes simplex virus type 1 was identified in the scrapings of linear corneal erosion. During treatment of herpetic keratitis, symptoms and signs of blepharitis deteriorated markedly, but as the patient was reluctant to use steroids, treatment of blepharitis proved to be difficult. The patient eventually gave his consent for using steroids and both blepharitis and ocular surface findings improved. ,Conclusion: In patients with atopic dermatitis, it is sometimes difficult to diagnose epithelial herpetic keratitis since the presence of AKC may lead to atypical lesions. It is therefore important to keep in mind both diseases during treatment. Furthermore, the concomitant treatment of atopic blepharitis is also necessary. In such cases, the clinician must to resolve the distrust of steroid medications often observed in atopic patients.

Journal

  • Journal of Tokyo Women's Medical College

    Journal of Tokyo Women's Medical College 82(-), E194-197, 2012-01

    Tokyo Women's Medical University

Codes

  • NII Article ID (NAID)
    110008767974
  • NII NACSIS-CAT ID (NCID)
    AN00161368
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • Journal Type
    大学紀要
  • ISSN
    0040-9022
  • NDL Article ID
    023518332
  • NDL Call No.
    Z19-400
  • Data Source
    NDL  NII-ELS  IR 
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