Unstable angina pectorisを契機に診断されたeosinophilic heart disease

Eosinophilic Heart Disease Manifested by Unstable Angina Pectoris: a case report

要旨　症例は33歳，男性．主訴は胸痛．家族歴，既往歴に特記すべきことなし．毎夕2〜3時間の胸痛を2週間繰り返すため当院に紹介された．初診時胸部に喘鳴を聴取した．心電図I，II，aVL，aVF誘導で陰性T波，V₄〜V₆でSTの低下と陰性T波を認めた．WBC 24,800/μl，特に好酸球が78％と著増していた．IgE456IU/ml，血漿IL-590.3pg/ml，GM-CSF16.4pg/ml，可溶性IL-2受容体h，950U/mlと増加していた。心エコー，心筋シンチグラフィ，左室造影検査で前壁中隔の収縮低下と虚血が疑われたが，冠動脈造影では有意な狭窄は認めなかった．ステロイド投与後，胸痛，喘鳴は消失し，末梢血好酸球数，心電図所見は正常化した．本例の冠動脈と気管支攣縮はサイトカインネットワークの変化と好酸球由来のmediatorにより引き起こされた可能性が推測された．

　A 33-year-old man noticed chest pain for 3 hours onevery evening in June, 1996. Physical examinationrevealed wheezing of bilateral lung stethoscopically.Electrocardiogram showed negative T wave in leads I, II, III, aVL, aVF, ST depression and negative T in leadsV_4-6 Laboratory examination of peripheral bloodshowed leukocvtosis (29,800/mm³) with marked eosinophilia (19,344/mm³). Levels of serum IgE, IL-5, solubleIL-2 receptor and plasma GM CSF were elevated to 456IU/ml, 90.3pg/ml, 1,950U/ml and 16.4pg/ml respectively. Both plasma and urinary histamine concentrationwere normal. Echocardiogram, cardiac scintigram andleft ventriculogram showed ischemia of anterior wall, while coronary arteriogram could not disclose anystenotic lesions.

　After administration of prednisolone, chest pain rapidly disappeared with decrease of peripheral blood eosinophil counts and with normalization of electrocardiogram. We speculated that both alteration of cytokinenetwork and some mediators released from eosinophilcaused coronary vasospasm and bronchospasm.