下腿の発疹を契機に診断された心不全合併チャーグ・ストラウス症候群の1例

A Case of Churg-Strauss Syndrome with Heart Failure

要旨　症例は60歳代女性．気管支喘息を指摘され加療を受けていたが，下腿の紫斑，下腿のしびれ，全身倦怠感を主訴に来院した．心電図にてⅡ，Ⅲ，aV_F，V4-6陰性T波V1-2 QSパターン，V1-3 ST上昇を認め，胸部X線にても心拡大，胸水を認め，採血にてProBNPの高値を認めた．心臓超音波検査にて後壁，下壁にて壁運動異常を認め，末梢血好酸球は11,988/μlと著明に上昇しており，下腿の皮膚生検からも好酸球を認め，チャーグ・ストラウス症候群と診断した．冠動脈造影や，心筋シンチグラフィーでは異常所見を認めず，心筋生検においてもステロイド投与後のためか特異的な所見は認めなかったが，ステロイド投与にて速やかに症状，検査所見の改善を認めた．チャーグ・ストラウス症候群は稀な疾患であるが，その心合併症は予後不良因子として知られ，早期発見，早期治療が重要である．心不全を合併したチャーグ・ストラウス症候群の1例を経験したので報告する．

　In our hospital, we treated a patient with Churg-Strauss syndrome(CCS)who experienced purple spot and numbness in the lower legs during treatment of bronchial asthma and developed heart failure. Electrocardiogram showed negative T waves in leads Ⅱ, Ⅲ, aV_F, and V4-6 with QS pattern in V1-2 and ST elevation in V1-3. Cardiac enlargement and pleural effusion were observed on chest x-ray. In addition, blood test results showed a high pro-brain natriuretic peptide(proBNP)level. Wall motion abnormality was detected in the posterior and inferior walls on echocardiography. After the initiation of steroid therapy and diuretic administration, symptoms were improved immediately. Abnormal findings were not observed in coronary angiography and myocardial scintigraphy. There were no specific findings in endomyocardial biopsy probably because of steroid administration. CCS is a rare disease. For its cardiac complications known as a poor prognostic factor, early detection and early treatment are important.