肝動脈瘤破裂を契機に診断された好酸球性多発血管炎性肉芽腫症の1例

A case of eosinophilic granulomatosis with polyangitis（EGPA）diagnosed through rupture of hepatic aneurysm

好酸球性多発血管炎性肉芽腫症（eosinophilic granulomatosis with polyangitis：EGPA）は，気管支喘息患者が好酸球増多を伴って全身性血管炎を発症する症候群である。消化器症状は約半数にみられる一般的な症状であるが，腹部内臓動脈瘤の破裂をきたす例はまれである。今回，我々は，肝動脈瘤の腹腔内破裂を契機にEGPAの診断に至った症例を経験したので，若干の文献的考察を加えて報告する。

We report a 79-year-old female with asthma manifesting acute abdominal pain. Diagnosed with acute cholecystitis, she was treated with antibiotics. On day 9, she suffered from hypovolemic shock. Contrast-enhanced CT revealed hemorrhagic ascites with multiple intrahepatic and mesenchymal aneurysms；intrahepatic one was probably ruptured. Angiography showed countless intrahepatic and mesenchymal aneurysms, and transarterial embolization for the ruptured one was performed. She followed an uneventful course without developing any complications. On the basis of multiple intrahepatic and mesenchymal aneurysms, her history of asthma, and eosinophilia in blood test, she was diagnosed as EGPA.