リウマチ熱心筋炎による心不全と考えられた維持透析患者の1剖検例

患者は糖尿病性腎症から末期腎不全となった70歳，男性血液透析症例．約4年前から肺水腫を伴う心不全を繰り返し，虚血性心疾患に対して経皮的冠動脈形成術を受けている．2年4カ月前に透析導入となった．今回，溢水のため入院し除水強化で心不全は一時的に改善したが，原因不明の発熱と炎症反応上昇により心不全は再び増悪し死亡した．剖検で心筋内にAschoff結節が散在し，リウマチ熱による心筋炎が心不全の悪化に関与したと考えられた．...

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Published in日本内科学会雑誌 Vol. 96; no. 7; pp. 1479 - 1482
Main Authors 原, 和弘, 森, 正也, 三村, 維真理, 三瀬, 直文, 西, 隆博, 崔, 啓子, 多川, 斉, 杉本, 徳一郎
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本内科学会 2007
Subjects
Aschoff結節
リウマチ熱
心不全
高齢透析患者
Online AccessGet full text
ISSN0021-5384
1883-2083
DOI10.2169/naika.96.1479

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Abstract 患者は糖尿病性腎症から末期腎不全となった70歳，男性血液透析症例．約4年前から肺水腫を伴う心不全を繰り返し，虚血性心疾患に対して経皮的冠動脈形成術を受けている．2年4カ月前に透析導入となった．今回，溢水のため入院し除水強化で心不全は一時的に改善したが，原因不明の発熱と炎症反応上昇により心不全は再び増悪し死亡した．剖検で心筋内にAschoff結節が散在し，リウマチ熱による心筋炎が心不全の悪化に関与したと考えられた．
AbstractList 患者は糖尿病性腎症から末期腎不全となった70歳，男性血液透析症例．約4年前から肺水腫を伴う心不全を繰り返し，虚血性心疾患に対して経皮的冠動脈形成術を受けている．2年4カ月前に透析導入となった．今回，溢水のため入院し除水強化で心不全は一時的に改善したが，原因不明の発熱と炎症反応上昇により心不全は再び増悪し死亡した．剖検で心筋内にAschoff結節が散在し，リウマチ熱による心筋炎が心不全の悪化に関与したと考えられた．
Author 原, 和弘
多川, 斉
森, 正也
崔, 啓子
三瀬, 直文
杉本, 徳一郎
三村, 維真理
西, 隆博
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References 3) Decker JP, et al: Rheumatic "activity" as judged by the presence of Aschoff bodies in auricular appendages of patients with mitral stenosis. Anatomic aspects. Circulation 8: 161-169, 1953.
5) Silver MD: Cardiovascular Pathology. 2nd ed, Churchill Livingstone, New York, 1991, 933-960.
7) Ruebner BH, Boitnott JK: The frequency of Aschoff bodies in atrial appendages of patients with mitral stenosis. Circulation 23: 550-561, 1961.
6) American Heart Association. Rheumatic Heart Disease Statistics. http://www.americanheart.org/presenter.jhtml?identifier=4712
8) Guadalajara JF, et al: Rheumatic carditis in the adult. Anatomical correlation. Arch Inst Cardiol Mex 60 (6): 541-546, 1990.
9) Kaplan EL, Markowitz M: The fall and rise of rheumatic fever in the United States: a commentary. Int J Cardiol 21 (1): 3-10, 1988.
2) Mcneely WF, et al: Rheumatic "activity" as judged by the presence of Aschoff bodies in auricular appendages of patients with mitral stenosis. Clinical aspects. Circulation 8: 337-344, 1953.
4) Virmani R, Roberts WC: Aschoff bodies in operatively excised atrial appendages and in papillary muscles frequency and clinical significance. Circulation 55(4): 559-563, 1977.
1) Committee on prevention of rheumatic fever and bacterial endocarditis and Carles H Rammelkamp: Prevention of rheumatic fever and bacterial endocarditis through control of Streptococcal infections. Circulation 15: 154-158, 1957.
10) Ayoub EM: Resurgence of rheumatic fever in the United States. The changing picture of a preventable illness. Postgrad Med 92 (3): 133-136, 139-142, 1992.
References_xml – reference: 4) Virmani R, Roberts WC: Aschoff bodies in operatively excised atrial appendages and in papillary muscles frequency and clinical significance. Circulation 55(4): 559-563, 1977.
– reference: 8) Guadalajara JF, et al: Rheumatic carditis in the adult. Anatomical correlation. Arch Inst Cardiol Mex 60 (6): 541-546, 1990.
– reference: 7) Ruebner BH, Boitnott JK: The frequency of Aschoff bodies in atrial appendages of patients with mitral stenosis. Circulation 23: 550-561, 1961.
– reference: 9) Kaplan EL, Markowitz M: The fall and rise of rheumatic fever in the United States: a commentary. Int J Cardiol 21 (1): 3-10, 1988.
– reference: 2) Mcneely WF, et al: Rheumatic "activity" as judged by the presence of Aschoff bodies in auricular appendages of patients with mitral stenosis. Clinical aspects. Circulation 8: 337-344, 1953.
– reference: 3) Decker JP, et al: Rheumatic "activity" as judged by the presence of Aschoff bodies in auricular appendages of patients with mitral stenosis. Anatomic aspects. Circulation 8: 161-169, 1953.
– reference: 1) Committee on prevention of rheumatic fever and bacterial endocarditis and Carles H Rammelkamp: Prevention of rheumatic fever and bacterial endocarditis through control of Streptococcal infections. Circulation 15: 154-158, 1957.
– reference: 6) American Heart Association. Rheumatic Heart Disease Statistics. http://www.americanheart.org/presenter.jhtml?identifier=4712
– reference: 10) Ayoub EM: Resurgence of rheumatic fever in the United States. The changing picture of a preventable illness. Postgrad Med 92 (3): 133-136, 139-142, 1992.
– reference: 5) Silver MD: Cardiovascular Pathology. 2nd ed, Churchill Livingstone, New York, 1991, 933-960.
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SubjectTerms Aschoff結節
リウマチ熱
心不全
高齢透析患者
Title リウマチ熱心筋炎による心不全と考えられた維持透析患者の1剖検例
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