良好な経過をたどった好酸球増多性心内膜心筋炎と思われる1例—本邦報告例25例の検討

A case of hypereosinophilic endomyocarditis showing benign clinical course:A case report and review of 25 cases of this syndrome in Japan

　1936年Löfflerが，最初に報告した好酸球増多性線維形成性壁心内膜炎^1）は，稀な疾患であり，好酸球増多症候群の一部としてとらえられている。その予後は良好とはいえない。今回我々は，薬物治療を行わないものの，発症4年後，良好な経過をとっている本症候群と思われる一例を経験したので，本邦報告例についての文献考察を加えて報告する。

A case of hypereosinophilic endomyocarditis ad-mitted to our hospital will be reported here with concomitant review of the literatures on 25 cases of this syndrome in Japan.

This is a 37 year old man who had been com-pletely well until November 1978, when he devel-oped confusion and abdominal pain. His ECG revealed T wave inversions in the limb and precor-dial leads and chest x-rays disclosed remarkable cardiomegaly and pulmonary congestion. The echo-cardiogram showed moderate pericardial effusion. Blood chemistry revealed the elevation of CPK and LDH levels and hematology showed leukocytosis and eosinophilia of 5,000/mm³ without abnormal blood cells. The stool examination revealed no parasites and related ovi. All immunological tests were nega-tive except for the scratch test of toxocara canis. No other test results were contributory to the cause of the disease.

The hypereosinophilia was spontaneously norma-lized and the patient recovered without any specific therapy. Four and a half years later, his hematology revealed no abnormalities. Hemodynamic evalua-tion including cardiac output by echocardiogram, left ventricular ejection fraction by RI method and STI were all within normal limits. Cardiac catherization with myocardial biopsy revealed normal intracardiac pressure profiles, endocardial fibrosis and hypertrophy of the working myocardium without thrombosis or eosinophilic mainfestations. His clinical course has been entirely benign.

Review of the literatures on 25 cases of this syn-drome in Japan indicates that many of the patients usually die of congestive heart failure and there seems to be no effective treatment established yet.