心筋梗塞が先行して発症した全身性バージャー病の1症例

A case of Buerger's disease with multiple arterial occlusion preceded by myocardial infarction

　四肢，特に下腿の中小動脈に好発するBuerger病は，時に心，大血管，腎，脾，腸管等の諸臓器に梗塞性病変を合併することが報告されている^1〜4）。しかし，全身の動脈に広範な閉塞を来たした症例は稀で，過去1例が報告されているにすぎない^5）。またBuerger病経過中に心筋梗塞を併発した症例は散見されるが^6），心筋梗塞が末梢動脈閉塞に先行したものはない。今回，臨床経過，剖検所見により，冠動脈に初発し，かつ広範な動脈病変を認めたBuerger病と考えられる症例を経験したので報告する。

Buerger's disease with multiple arterial occlusion is very rare and only one case of "systemic Buer-ger's disease" has been reported. On the other hand, several cases of this disease with coronary artery involvement have been published. However the case of Buerger's disease preceded by myocar-dial infarction is not present. This paper described a 46-year-old smoking male with "systemic Buerge-r's disease" after the attack of myocardial infarction at the age of 28 at anteroseptal portion of the left ventricle.

After the episode, he felt a intermittent claudi-cation at age of 32, and clinical diagnosis of Buer-ger's disease was made by femoral artery angio-graphy, which demonstrated an abrupt occlusion of femoral artery with smooth arterial wall and well developed collateral arteries. Because of necro-sis at the right leg, he received amputation of the leg. His symptom was not improved and sympa-thectomy was additionary performed. At 42 year-old, he lost consciousness and was clinically dia-gnozed as transient ischemic attack. At the age of 45, he became suddenly dyspneic secondary to pu-lmonary infarction. One years later, acute renal failure and paralytic ileus caused by thrombosis of renal and supramesenteric arteries led him to fetal disaster.

His laboratory data included platelet count of 35.8×10⁴/mm³ fibrinogen of 542 mg/dl, antithrombin III of 87 ug/ml, plasminogen level of 1.752 RCU and euglobin lysis time of 5 hours showing a de-crease of fibrinolytic activity at the time of 39 years old.

Postmortem examination revealed old organized thrombosis at lower abdominal aorta, femoral, com-mon iliac and external iliac arteries and partially organised mural thrombi at entire circumference of the abdominal aorta that occluded up to the orifice of celiac artery. Myocardial infarction scar was demonstrated at both anteroseptal and poste-rior wall together with organized thrombotic occlu-sion of the left anterior descending artery and many recanalized vessels. Histologically, above-mentioned arteries included slightly inflammatory reactions.

From these pathological findings and angiogra-phical study, this case was considered to be the first case of "systemic Buerger's disease" whose initial symptom was coronary artery thrombosis.