日本性感染症学会誌 Journal of Japanese Society for Sexually Transmitted Infections

Online ISSN: 2434-2505 Print ISSN: 0917-0324
日本性感染症学会 Japanese Society for Sexually Transmitted Infections
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society for Sexually Transmitted Infections Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Japanese Journal of Sexually Transmitted Infections 32(1): 1-6 (2021)
doi:10.24775/jjsti.R-2021-0001

総説総説

眼梅毒アップデートOcular Syphilis Update

国立国際医療研究センター眼科National Center for Global Health and Medicine Department of Ophthalmology

発行日:2021年10月27日Published: October 27, 2021
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先天眼梅毒では網脈絡膜炎、虹彩炎、涙嚢炎、角膜実質炎を生じる。後天眼梅毒では梅毒性ぶどう膜炎の他、角膜実質炎、強膜炎、視神経炎、眼瞼ゴム腫、Argyll Robertson瞳孔などがみられる。梅毒性ぶどう膜炎は硝子体混濁、散在性網脈絡膜炎、網膜血管炎、Acute Syphilitic Posterior Placoid chorioretinitisなどがみられるが、多彩な眼所見を呈するため梅毒血清反応が診断の鍵となる。強膜炎を合併することもあり、難治性強膜炎では梅毒を疑う必要がある。HIVとの重複感染や再感染により臨床像が複雑となる場合、眼内液網羅的PCR法が診断に有用である。眼梅毒の多くは神経梅毒を合併しているため、米国CDCは神経梅毒に準じた治療を奨励している。視力予後は一般に良好だが、視力予後に影響を及ぼす視神経病変が疑われる場合は、早急に髄液検査を施行し、診断および治療を行う必要がある。

Congenital ocular syphilis causes chorioretinitis, iritis, dacryocystitis, and interstitial keratitis. Syphilitic uveitis, stromal keratitis, scleritis, and optic neuritis develop after the second stage of acquired ocular syphilis, and gummas of the eyelids and Argyll Robertson pupil are seen in the third stage. In syphilitic uveitis, vitreous opacity, multifocal choroiditis, retinal vasculitis, and acute syphilitic posterior placoid chorioretinitis are seen, and because of the variety of ocular findings, a serologic test for syphilis is the key to accurate diagnosis. Although not widely recognized, scleritis can also occur, and syphilis should also be suspected in intractable scleritis. A multiplex polymerase chain reaction procedure that uses intraocular fluid is helpful in the diagnosis of ocular syphilis because the ocular findings become complicated when they overlap with a human immunodeficiency virus infection or reinfection. Since most cases of ocular syphilis are associated with neurosyphilis, the guidelines proposed by the U.S. Center for Disease Control encourage treatment in accordance with neurosyphilis. The prognosis for visual acuity is good; however, early diagnosis is important. If optic nerve manifestations, which may affect visual acuity, are suspected, a cerebral spinal fluid examination should be performed as soon as possible for early diagnosis and treatment.

Key words: ocular; optic neuritis; scleritis; syphilis; uveitis

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This page was last modified on 2021-10-21T10:37:51.000+09:00


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