細菌性心内膜炎に合併した冠栓塞の1剖検例

Coronary Embolism in Bacterial Endocarditis Report of A Case (Autopsy)

I．まえおき

　冠栓塞の報告は比較的少く，しかも，臨床的並びに剖検上より同時にこれを確認しえた症例は極めて少ない。Wenger，Bauer^1））らによる1929〜1957年間のMount Sinai Hospitalの統計では，総剖検数17,469例中，冠栓塞例は11例（0.06％）にすぎない。本邦での報告は，われわれの調査では，剖検確認例は，わずかに東大上田内科編集「図説臨床心電図」^2））の2例と札幌医大宮原氏^3））らの1例との計3例である。最近，われわれは18才の男子で，細菌性心内膜炎に冠栓塞を合併し，心電図上明らかな後壁側壁梗塞の像を呈し，しかも，短時日で死亡し，剖検でこれを確認しえた1症例を経験したので，文献的考察を加えて報告する。

A case of coronary artery embolism associated with bacterial endocarditis is described. An eighteen-year-old college male student entered the hospital because of precordial pain and fever. On admission, the patient showed a marked increased sedimentation rate, leucocytosis, anemia and albuminuria. Moreover, the pattern of postero-lateral infarction appeared in E. C. G. The patient died forty-eight hours after admission. In autopsy, severe destruction, deformity and thickness were observed in the aortic valve. It was interesting to notethat gram-positive cocci were found at the edge of the aortic valve. There was rupture of left coronary artery with a resulting large infarction.

Author discussed this as a late complication in clinically healded bacterial endocarditis. The possibility which often occurs when administration of antibiotic drugs is an inadequate.