佐藤 健夫

症例は60歳，女性．半年以上診断が確定しなかった発熱の経過中に失行，構音障害，幻覚などの多彩な中枢神経症状が加わり，増悪した．血管内リンパ腫を疑い，骨髄生検と肝生検をはじめとする検査を施行したが診断は確定しなかった．皮疹は認められなかったが，ランダム皮膚生検によって血管内リンパ腫が確定し，化学療法が奏功した．<br>

We described clinicopathological features of eight patients (six females and two males) with isolated polyarteritis nodosa (PN). The age range of the patients was from 22 to 85 years. Six patients presented with fever, skin involvement and/or peripheral neuropathy related to the vasculitis. One patient presented with appendicitis, and the other patient presented with ovarian cyst. Biopsy specimens were obtained from 5 patients with skin and/or peripheral nerve involvement, and surgically resected specimens were obtained from one patient with appendicitis and from one patient with ovarian cyst. Fibrinoid necrosis of small to medium sized arteries was observed in all specimens. After resection, a patient with necrotizing vasculitis of the vermis and a patient with necrotizing vasculitis of the genital tract have not developed systemic vasculitis during the follow-up years. Four patients with peripheral nerve involvement responded well to high dose prednisolone therapy, however, two patients with PN confined to the skin (cutaneous PN) had frequent relapses, indicating that cutaneous PN has not necessarily a benign course.

症例は気管支喘息とアレルギー性鼻炎の既往がある92歳男性.経過中にメチシリン耐性ブドウ球菌・多剤耐性腸球菌による敗血症を繰り返したため抗生剤を投与した.抗生剤投与中に皮疹・肝障害・末梢血液中好酸球数増加が出現し, その経過に一致して心不全による呼吸困難感および胸水貯留, 心電図異常, び漫性心筋収縮能低下が出現した.抗生剤中止とステロイド剤投与により, 皮疹・肝障害・末梢血液中好酸球増多は改善, それに伴い心不全も軽快した.治療経過より好酸球増多は塩酸バンコマイシンもしくはテイコプラニンによる薬剤性を疑った.薬剤性好酸球増多症による心筋障害は稀であるが, 生命予後を左右する重大な合併症の一つである.本例は抗生剤投与中止とステロイド剤投与により治療し得た.