Abstract: Here, we present a case of right eyelid drooping in a 79-year-old man. Neurological examination revealed ptosis of the right eye without severe painful eyelid swelling and redness. An ocular motility examination of the right eye revealed upward limitation and downward overshoot. The results of routine blood examinations were within normal limits, and no autoantibodies were detected. Orbital magnetic resonance images revealed mild right eyelid swelling and lacrimal gland enlargement, indicating orbital inflammation. The ocular discharge was positive for Staphylococcus hominis by culture and the patient was diagnosed as having acute dacryoadenitis. Treatment with topical and systemic administration of antibiotics rapidly improved symptoms. Ocular infection is not usually suspected in the absence of local severe painful swelling and redness, and painless acute dacryoadenitis presenting as ophthalmoplegia and ptosis may be misdiagnosed. Orbital inflammation may rapidly progress to orbital cellulitis with treatment delay, which may also lead to aggravation of ophthalmic prognosis. Therefore, neurologists should be aware of the possibility of acute dacryoadenitis occurring without the local severe inflammatory findings mimicking neurological diseases, and acute dacryoadenitis should be considered in patients with ophthalmoplegia even in the absence of severe painful eyelid swelling and redness.
症例は72歳女性である．2型糖尿病で通院治療中であった．7年前に左肺多発結節影があり精査するも診断に至らず経過観察で縮小した．その後呼吸器症状もなく安定していたが，5ヶ月の経過で認知機能障害と歩行障害が進行し入院し，クリプトコッカス髄膜脳炎と診断された．両足趾右優位にアテトーシス様の不随意運動を認めた．不随意運動はpainful legs and moving toesに極めて類似していたが，疼痛は全くなかった．クリプトコッカス髄膜脳炎で認知機能障害，不随意運動の改善過程を観察した報告は稀であり，貴重な症例であると考えられたため報告する．