心サルコイドーシスの1症例

A case of myocardial sarcoidosis

　サルコイドーシスは，原因不明の慢性類上皮細胞肉芽腫であり，約70％の症例は，自然治癒する予後良好な疾患である。しかし5〜l0％の症例は，心臓，中枢神経，肺に浸潤し，死亡する^1）。死亡原因として以前は肺性心が多いといわれていたが，最近では心臓死が多く，注目されている^2）。心臓死の原因別については，Roberts^3）が，心サルコイドーシス113例中，60例が不整脈による突然死，20例がうっ血性心不全によって死亡したと報告している。今回我々は，徐脈，完全房室ブロックのため，ペースメーカー植込み，3年間心不全をくりかえし，徐々にサルコイドーシスによる心臓病変の為に，正常な刺激伝導路系，正常な心筋細胞が少なくなり，ペースメーカー作動が無効となり死亡され，剖検施行した1症例を経験したので，若干の文献考察をあわせて報告する。

A 52-year-old woman was admitted to Nagoya City University hospital because of dyspnea. Two months before the first admission, she awoke with anterior chest pain and palpitation. An electro-cardiogram (ECG) at this time showed the first degree AV block, the complete right bundle branch block and the abnormal left axis deviation. At the first admission, ECG showed the complete AV block, and she was implanted a demand type pacemaker. She was diagnosed sarcoidosis by bilateral hilar lymphoadenopathy at chest X-ray, silica granuloma by skin biopsy, a positive Kveim's reaction, and eye lesion. At the second, the third admission, she awoke with dyspnea. The dyspnea was disappeared by the treatment of steroid, antiarrhythmic drug and diuretics. This combination therapy controlled heart failure. Pour years after the last admission, she awoke with severe dyspnea, had frequent ventricular premature beats at ECG and 62% of cardio-thoratic ratio. The progressive arrhythmia and severe congestive heart failure in this case may be due to myocardial sarcoidosis. The combination therapy with pacemaker can be long-lived for the patient with myocardial sarcoidosis. Congestive heart failure was progressed and she was died. At autopsy, myocardial sarcoidosis was confirmed by the granuloma without caseating necrosis found in the heart, lymph-node in the hilus and parabronchus.