Ikeda Asako, Ikeda Tomohiro, Ikeda Naohiro, Kawakami Yoshimi, Mimura Osamu
Department of Ophthalmology, Takarazuka City Hospital, Takarazuka, Japan.
Jpn J Ophthalmol. 2006 May-Jun;50(3):280-3. doi: 10.1007/s10384-005-0308-7.
Leber's hereditary optic neuropathy (LHON) predominantly affects young men between 10 and 30 years of age. However, two cases of LHON during ethambutol administration have been reported in older men and one case in an older woman. We now report a second case of an older woman in whom administration of ethambutol triggered the development of LHON.
A 70-year-old woman received ethambutol, rifampicin, isoniazid, and pyrazinamide for the treatment of tuberculosis.
Three months after the beginning of this treatment, a marked decrease in visual acuity occurred in both eyes and ethambutol was discontinued. Her corrected visual acuity was 0.03 in both eyes. There was no hyperemia, swelling of the optic disc, or capillary dilatation in either eye. Centrocecal scotomas were found bilaterally. After 1 month, her visual acuity had further decreased to 0.01, and the scotomas had enlarged. At this time, genetic analysis revealed a point mutation in mitochondrial DNA 11778.
Ethambutol can be a risk factor for LHON because the number of reported ethambutol-related LHON cases has increased to four, including the present one. Ethambutol administration to patients with a family history of LHON should be avoided.
Leber遗传性视神经病变（LHON）主要影响10至30岁的年轻男性。然而，已有两例老年男性在使用乙胺丁醇期间发生LHON的报道，以及一例老年女性发生LHON的报道。我们现报告第二例老年女性，其使用乙胺丁醇引发了LHON的发生。
一名70岁女性接受乙胺丁醇、利福平、异烟肼和吡嗪酰胺治疗结核病。
该治疗开始三个月后，双眼视力显著下降，乙胺丁醇停药。她双眼矫正视力均为0.03。双眼均无充血、视盘肿胀或毛细血管扩张。双侧发现中心暗点。1个月后，她的视力进一步下降至0.01，暗点扩大。此时，基因分析显示线粒体DNA 11778存在点突变。
乙胺丁醇可能是LHON的一个危险因素，因为包括本病例在内，乙胺丁醇相关LHON病例报告数量已增至4例。应避免对有LHON家族史的患者使用乙胺丁醇。
