感染性心内膜炎を原因とする多発動脈閉塞で発見された腎梗塞

Renal infarction with multiple embolism of artery caused by infective endocarditis

　症例は57歳，女性。既往歴は僧帽弁逸脱症である。主訴は発熱と腰痛で，造影CTにて両腎に楔状低吸収域を認めたため両側急性腎盂腎炎と診断し抗生剤療法を開始した。しかし改善傾向なく，心音で全収縮期雑音，下肢血管痛が出現し，心臓超音波で僧帽弁の肥厚，MR血管造影で下肢多発動脈閉塞を認めた。さらに血清GOT，ALPの上昇から考え，感染性心内膜炎で発症した多発動脈閉塞を伴う腎梗塞と診断された。

　A 57-year-old woman with a chief complaint of high fever and lumbago was admitted to our hospital. She had a history of mitral valve prolapse. Since enhanced CT revealed triangular-shaped perfusion defect in the bilateral kidney suggesting acute pyelonephritis,antibiotic therapy was performed. However the patient remained febrile with vascular tenderness of lower extremities. Auscultation of the heart disclosed a holosystolic murmur. MR angiography revealed multiple arterial embolism of the lower extremities. Ultrasonic cardiography revealed prominent thickening of mitral valve. Serum GOT and ALP was increased. It was thought that renal infarction in this case with multiple embolism of artery was caused by infective endocarditis.