術後早期再発したIgG4関連収縮性心膜炎に著効したステロイド治療

Successful Steroid Therapy for Early Relapse of Immunoglobulin （Ig） G4 Related Constrictive Pericarditis

収縮性心膜炎は，心膜の炎症で心外膜が肥厚・瘢痕化し，心室の拡張障害をきたす疾患である．その原因として心臓手術後，放射線治療後，膠原病，結核性などが知られているが，近年は免疫グロブリンG4（IgG4）関連疾患による収縮性心膜炎の報告も増えている1）．収縮性心膜炎の治療としては心膜剝皮術やワッフル切開術があるが，IgG4関連疾患による収縮性心膜炎に対してはステロイド治療が奏効する場合がある2）．われわれは心膜剝皮術後早期に再燃したIgG4関連収縮性心膜炎の症例に対し，ステロイド投与が著効した1例を経験したため報告する．

The causes of constrictive pericarditis are known to include previous cardiac surgery, radiotherapy, collagen disease, and tuberculosis, but in recent years, reports of constrictive pericarditis due to immunoglobulin （Ig） G4-related diseases have increased. We report a case of IgG4-related constrictive pericarditis that relapsed early after pericardiectomy and was well controlled by steroid therapy. The patient was a 69-year-old man who was diagnosed with idiopathic constrictive pericarditis. He underwent pericardiectomy and very early postoperative course was favorable, but the disease recurred around a week or so. Postoperative pathological examination and immunohistochemistry revealed IgG4-related constrictive pericarditis, and steroid therapy was started. The patient’s heart failure symptoms were alleviated, and thickened pericardium got thin following steroid therapy. During treatment of constrictive pericarditis, it is necessary to keep IgG4-related diseases in mind.