薬疹の経過中に胸膜炎および心膜心筋炎を合併した1例

A case associated with pleuritis and myopericarditis in the course of drug-induced eruption

　急性心筋炎の原因としてはウイルス感染がよく知られているが^1），薬物アレルギー^2〜4）や好酸球増多症候群（HES）にみられる心筋炎^5,6）も報告されている。著者らは上気道炎を初発症状とし，薬疹の経過中にステロイド剤の中断で著明な好酸球増多症と胸膜炎および心膜心筋炎を併発したが，ステロイド剤の再投与により改善しえた1例を経験したので報告する。

The patient is a 33 year old woman who suffered from toxicodermia because of cefaclor administrated to upper air tract infection, and fever, dry cough, shor-tness of breath developed by withdrawal of steroid. Chest x-ray films disclosed remarkable cardiomegaly and bilateral pleural effusion. ECG revealed inverted T wave and poor R wave progression in the precordial leads. Blood chemistry tests showed the elevation of CPK, LDH. GOT and haematological studies showed leukocytosis and eosinophilia of 5, SOO/cmm. The titers of antibody for virus were not elevated. The echocardio-gram showed massive pericardial effusion. Myocardial biopsy revealed myocardial degeneration with myocy-tolysis, interstitial edema, fibrosis and mononuclear cell infiltration.

This case does not fall into the conventional spectrum of acute viral myocarditis. It is conceivable that myo-carditis, pleuritis and eosinophilia in this patient were caused by a series of drug hypersensitivity.