化学療法のみで著明な心不全の改善を認めた骨髄腫心の1例

A Case of Multiple Myeloma with Heart Failure Improved Remarkably by Chemotherapy Alone

　化学療法のみで著明な心不全の改善を認めた稀な骨髄腫の1例を経験した．患者は50歳男性．貧血と血尿を主訴とし来院．入院時検査にて比較的珍しいIgGκ型骨髄腫と腎癌の合併と診断された．胸部X線では心拡大と肺うっ血が観察され心エコー図でも左室拡大・壁運動低下を呈した．心筋生検では，アミロイドの沈着は認めず，腎癌の手術に先だって行った化学療法は骨髄腫のコントロールに有効であったのみでなく，肺うっ血および心不全も軽快させた．

　本例における心機能低下は，アミロイドによるものではなく，骨髄腫における粘調性の亢進によるものと考えられた．

A rare case is reported, in which heart failure in a patient with multiple myeloma without amyloidosis was improved following chemotherapy for the myeloma. The patient, a 50 year-old man, came to our hospital for examination because of anemia and hematuria. He was diagnosed as having an IgGκ type of myeloma with the relatively rare complication of renal cancer. A chest X -ray revealed cardiomegaly and pulmonary congestion. An echocardiogram revealed an enlarged left ventricle with decreased wall motion.

No cardiac amyloid deposits were detected upon endomyocardial biopsy.