肝疾患に続発した高コレステロール血性黄色腫の1例

XANTHOMATA WITH SECONDARY HYPERCHOLESTEREMIA DUE TO LIVER DISEASE

I．緒言

　黄色腫は古くから知られている疾患の1つであり，その臨床所見，血液学的所見，病理組織学的所見，全身病的な関連などの観点から分類されており，多くの病型が知られているが，その本態に関して尚明らかにされてない点が少くない^1）。

　このような黄色腫のうちで，肝疾患に高コレステロール血症を伴つて来るものが知られている。本邦においては，この型に属する黄色腫は稀であるとされており，10余例^2〜16）が報告されているに留るようである。

A 36-year-old woman had an episode of fever and jaundice with cholecystitis and liver function disturbance 4 months before the first visit, which was improved by 3 months' treatment

At that time she found yellow lesions on the eyelids and palms.

At her first, she had jaundice, and flat yellow nodules on both the canthi, and cord-like yellow nodules on the neck, axillae, cubital regions, palms, groins, and flexor surfaces of fingers.

Laboratory studies of patient's blood disclosed the following values : icteric index 15.3, total cholesterol 524 mg/dl, total lipid 813 mg/dl, alkaline phosphatase 49.6 u, GOT 113 u, GPT 142 u, A/G 1.70. Serum protein fractions by Tiseliuse were as follows : Albumin 62.9%, α₁-globulin 3.9%, α₂-globulin 12.0%, β-globulin 10.3%, and γ-globulin 10.9%.

Histologic specimen from yellow nodule revealed dense infiltration of foam cells containing neutral fat and cholesterol in the papillary and subpapillary layer of the dermis.

Histologic section of liver biopsy showed swollen and turbid liver cells, mild fibrosis and inflammatory infiltrate in and around the Glison's capsule.

After 5 months treatment of Clofibrate and Thioctic acid xanthomata except those on the eyelids disappeared, and results of laboratory examinations returned to normal level.