種々の心病変を示したサルコイドーシスの1例

A case of cardiac sarcoidosis with various clinical manifestations

　サルコイドーシスは，肺やリンパ節を侵す全身的系統疾患として注目されているが，未だその原因は不明である。本症の死因としては心臓死が多く，剖検例も多く報告されているが，生前に心筋生検により診断し得た例は少ない。著者らは，種々の心電図異常，うっ血性心不全，僧帽弁逆流，左室収縮異常などの多彩な心病変を示し，ペースメーカー植え込み時に施行した心筋生検により心サルコイドーシスと生前に診断し得た例を経験したので報告する。

Sarcoidosis has been recognized as a systemic disease that may involve the lung, lymph nodes and some other organs, and death is most frequently caused by cardiac involvement. The diagnosis has rarely been performed during life. We experienced a case with serious manifestations of cardiac sarcoi-dosis.

A 37-year-old man was admitted to our hospital because of dyspnea. His electrocardiogram (ECG) at this time showed incomplete right bundle branch block RBBB), abnormal Q wave and multifocal ventricular premature beats. His bundle electro-cardiogram HBE) showed prolongation of H-V interval. Cardiac catheterization and cineangiograms revealed intact coronary artery, mitral regurgitation and abnormal contraction of posterior left ventri-cular wall. He was suspected as cardiac sarcoidosis. After the administration of corticosteroid hormone, he was discharged in good condition. At the second admission, ECG showed the first degree A-V block and complete RBB in addition to the previous findings. At the time of implantation of an epicardial pacemaker, myocardial biopsy was per-formed, and it showed the noncaseating granuloms of sarcoidosis.

This case was diagnosed as cardiac sarcoidosis with various clinical manifestations during life. Corticosteroid therapy in its early stage and implan-tation of the artificial pacemaker, if necessary, would be expected to be effective for preventation of the sudden cardiac death.