一名重疊症候群的病人併發兩邊中心視網膜動脈栓塞及抗磷脂抗體的關連性

Bilateral Central Retinal Artery Occlusions in a Patient with Overlap Syndrome Associated with Antiphospholipid Antibody

一位25歲男性病人因發燒一個月住進台大醫院，理學檢查發現有身上紅斑及近端肌力減弱。實驗室數據顯示血清中有各種自體抗體，及IgG和IgM抗磷脂抗體。影像檢查有兩邊肺下野侵襲，心胞膜積水及肝臟脂肪化。活體切片有肌肉炎及真皮炎併狼瘡帶，診斷為紅斑性狼瘡和皮肌炎的重疊症候群。病人對類固醇治療反應良好。半年後有兩眼的暫時失明，接著發生癲癇。眼底檢查有兩邊櫻桃紅斑點，眼底血管攝影發現有兩側中心視網膜動脈栓塞。腦脊髓液中含有高的IgG及IgM抗磷脂抗體。病人的視力在大量類固醇的治療下有進步。抗磷脂抗體的存在可能造成中心視網膜動脈的栓塞，吾人特別提出報告。

A 25-year-old male patient with skin rash and proximal muscle weakness was admitted, and overlap syndrome including systemic lupus erythematosus and dermatomyositis was diagnosed. Transient loss of visions occured 6 months later, and seizure with coma followed. Retinopathy and occlusions of bilateral central retinal arteries were documented by fluorescence angiograms. Laboratory tests showed highly elevated IgG and IgM isotypes anticardiolipin antibody both in serum and cerebrospinal fluid. High dose of corticosteroid was tried with improvement. The antiphospholipid antibodies may cause central retinal artery occlusion of this patient.