気管支喘息発作に関連した好酸球増多を伴う難治性異型狭心症の1例

A Case of Refractory Vasospastic Angina with Eosinophilia Associated with Bronchial Asthma

要旨　患者は61歳，女性．気管支喘息，冠攣縮性狭心症の診断にてカルシウム拮抗剤，亜硝酸剤，スタチン，プレドニゾロン(PSL)を内服していた．胸部違和感，嘔気・嘔吐，呼吸困難にて救急搬送となった．1カ月ほど前にPSLを5mg/日から3mg/日に減量していた．搬送中に徐脈と意識消失を呈した．冠動脈造影にて冠攣縮を認め，カルシウム拮抗剤，硝酸イソソルビドを増量し，ニコランジルを追加，気管支喘息吸入薬を追加するも喘息発作に続く心原性ショックを繰り返し，メチルプレドニゾロン40mg/6時間，その後はPSL 20mg/日，最終5mg/日にて独歩退院となった．搬送時好酸球は29%と増多を示し，退院時は0%であった．ステロイドにより冠動脈局所アレルギー反応を抑えたことで冠攣縮が鎮静化したと考えられた．気管支喘息発作に関連した好酸球増多を伴う難治性多枝異型狭心症に対しPSL増量にて対処しえた症例を経験したので報告する．

　A-61-year-old woman, who had been diagnosed with vasospastic angina and bronchial asthma was transported to our institution with chest oppression, nausea, vomiting, and dyspnea. She had already taken a calcium antagonist, nitrite, statin and prednisolone (PSL). She had reduced the quantity of PSL 5mg/day to 3mg/day about one month before. Her heart rate fell and she lost consciousness temporarily in the ambulance. Emergent coronary angiography revealed multi-vessel spastic angina. Although Calcium antagonist, nitrite, nicorandil, and inhalation therapy were added, bronchial asthmatic attack and cardiogenic shock recurred. Intravenous administration of methylprednisolone 40mg/6hr followed by oral PSL 20mg/day finally 5mg/day was initiated. She was discharged without any relapse of attacks, and her condition is improving. A high eosinophil count(29%)was found, when she was admitted, and it was 0% when she was discharged. The coronary spasm may have been controlled due to the anti-inframmatory effect of corticosteroid to the hyperresponsiveness of the vascular wall. We report a case of refractory vasospastic angina with eosinophilia associated with bronchial asthma controlled with corticosteroid.