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要約 目的:フルオレセインによるアナフィラキシーで死亡した患者に,重篤な心疾患が剖検で発見された報告。症例:65歳男性が硝子体出血を伴う左網膜静脈分枝閉塞症で受診した。経過:初回の蛍光眼底造影検査(fluorescein angiography:以下,FA)では,副作用はなかった。7か月後の2回目のFAでは,フルオレセイン静注2分後にアナフィラキシー様症状が出現し,直ちに適切な処置が行われたが,心肺停止となった。その後の集中的治療によっても血行動態は回復せず,2日後に死亡した。病理解剖で高度の心肥大を認め,治療への反応不良の主因と考えられた。結論:FA施行前には十分な問診と,場合によっては心疾患のスクリーニングが必要である。
Abstract. Purpose:To report a fatal case of anaphylaxis caused by intravenous fluorescein found a severe heart disease. Case:A 65-year-old male presented with vitreous hemorrhage and branch retinal vein occlusion in the left eye. Findings:In the first session of fluorescein angiography(FA), no adverse reaction occurred. The second FA was performed 7 months later. 2 minutes after the administration of intravenous fluorescein, the patient showed anaphylactic reaction. Despite of quick and proper treatment, the patient entered cardiopulmonary arrest. Following intensive care failed to induce recovery of hemodynamics, and he died after 2 days. Autopsy revealed severe cardiac hypertrophy, suggesting that his cardiac dysfunction was the main factor of poor response to critical care. Conclusion:Prior to FA, detailed interview about patient's condition is necessary. Screening test for heart disease should to be done as required.
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