本態性血小板血症に合併した難治性鼻出血の1例

A case of essential thrombocythemia with refractory nasal bleeding

はじめに

　本態性血小板血症（essential thrombocythemia：ET）は骨髄増殖性腫瘍の1つで，造血幹細胞レベルでの腫瘍化のため骨髄内の巨核球が著増し，血中の血小板増加がみられる稀な疾患である。血栓症あるいは出血傾向が起こりうるが，診断契機として健康診断などでの血液検査で指摘され，無症状で発見されることも多い。耳鼻咽喉科領域でETを合併した症例の報告^1）はきわめて稀で，本邦で鼻出血の報告はない。

　今回われわれは，人間ドックでの血液検査で血小板数の異常を契機に診断されたET症例で，鼻出血の治療に際し気道確保のための気管内挿管ならびに血管内治療を要した難治性鼻出血症例を経験したので報告する。

　Here, we report a rare case of essential thrombocythemia with refractory nasal bleeding. A 64-year-old man with epistaxis from the right nasal cavity was emergently transported to our hospital following a two-year history of essential thrombocythemia. Nasal packing was able to control the nasal bleeding. However, due to the possibility of rebleeding, angiographic embolization was carried out through a branch of the right maxillary artery. Unfortunately, rebleeding occurred after the removal of the nasal packing. To prevent suffocation, tracheal intubation was performed. Treatment with contralateral maxillary artery embolization improved his condition. His postoperative course was uneventful.