多発性骨髄腫に肺血管性肺高血圧症を合併した1例

A Case of Pulmonary Artery Pulmonary Hypertension Complicated by Multiple Myeloma

要旨　IgGκ型多発性骨髄腫に対し化学療法施行後に，肺血管性肺高血圧症を合併した症例を経験した．症例は81歳，男性．両下腿浮腫を主訴に近医受診し，高蛋白血症を認めたため当院紹介され多発性骨髄腫と診断治療された．その後，安静時呼吸困難を主訴に救急受診，完全房室ブロックを認め入院した．入院時右心カテーテル検査で，肺動脈圧の上昇，前毛細血管性肺高血圧症と診断した．多発性骨髄腫の新規治療薬の登場と同時に血栓塞栓症とそれに伴う肺高血圧症の発症の報告はあるが¹⁾，本症例において血栓塞栓症を疑う所見がなく肺塞栓症は否定的であった．肺血管性肺高血圧症の発症との因果関係について，これまでまとまった見解はほとんどなく，貴重な症例と考え文献的考察を含め報告する．

　Herein, we report a case of pulmonary hypertension as a complication after treatment for multiple myeloma. An 80-year-old man with a complaint of bilateral leg edema consulted a general practitioner, and he was referred to our hospital for hyperproteinemia. As the patient was diagnosed with multiple myeloma, chemotherapy was initiated. After 2 weeks, the patient was admitted to the emergency department owing to the development of dyspnea at rest, and temporary pacing was performed for a complete atrioventricular block. Using the results of diagnostic cardiac catheterization, we diagnosed the patient with pulmonary hypertension. Along with the recent developments in the treatment of multiple myeloma, the incidence of thromboembolic diseases complicated by pulmonary hypertension has been increasing. However, pulmonary embolism was diagnosed in this patient. Because there are only few reports about multiple myeloma complicated by pulmonary hypertension, we report this valuable case.