慢性副鼻腔炎が誘因と考えられた血管性浮腫症例

A Case of Angioedema associated with Chronic Sinusitis

　はじめに

　血管神経性浮腫（angioneurotic edema）は皮下，粘膜下組織に原因不明の発作性限局性浮腫を生じる疾患であり，1882年Quincke^1）により報告されて以来，その原因にかかわらずクインケ浮腫と呼ばれている。1888年Osler^2）は，血管神経性浮腫のなかで遺伝性を有するものを遺伝性血管神経性浮腫（hereditary angioneurotic edema：HANE）と報告し，遺伝性の有無により遺伝性血管神経性浮腫と血管神経性浮腫に大別した。現在では「神経」は省かれ遺伝性血管性浮腫（HAE）や血管性浮腫（angioedem）と呼ばれている。

　今回われわれは慢性副鼻腔炎が発症の誘因と考えられた血管性浮腫症例を経験したので，若干の文献的考察を加え報告する。

A 49-year-old male patient complained of edema and a slight pain in the right eyelids. The symptoms had occured three times in a month without any apparent causes since 1993 and had disappeared spontaneously within one to three days. CT scan findings revealed mucoperiosteal thickening of the bilateral ethmoid sinuses and the right sphenoid sinus. From the results of examinations and charac-teristic clinical symtoms, he was diagnosed as hav-ing angioedema associated with chronic sinusitis. The patient was treated with prednisolone 40 mg to 1.75mg for five months. After ameliorating the symptoms, endoscopic endonasal sinus surgery was performed for removal of inflammed paranasal mucosa. The patient has remained free of an-gioedema a year and nine months postoperatively.