一過性の洞停止・2度房室ブロックを呈した高齢者リウマチ熱の1例

An Adult Case of Rheumatic Fever Accompanied with Transient Sinus Arrest and Second-Degree Atrioventricular Block

　症例は71歳，女性．2週間持続する発熱と胸部不快感を主訴に当院を受診し，心電図にて1度房室ブロック，洞停止，左脚ブロックなど数十分単位で変化する多彩な異常を認めたため，精査目的で入院となった．血液検査より中等度炎症所見が認められ，心筋炎を疑って心臓超音波検査を実施したが，異常所見は認められず，CPKも正常であった．入院8病日より，多発性関節炎，紅斑，アキレス腱痛が出現し，血液検査にてASO,ASKの上昇を認めたためリウマチ熱と診断した．後日，電気生理学的検査を実施したが異常所見は認められていない．高齢者でリウマチ熱により一過性洞機能不全を呈した症例は報告がなく貴重な症例と考え，ここに報告する．

A 71-year-old woman was admitted to our hospital because of fever and palpitation. The ECG was very variable and showed first-degree AV block, transient sinus arrest, and left bundle branch block for 24 hours. Myocarditis was excluded because two-dimensional echocardiography revealed normal wall motion, and serum CPI was not elevated. On the 8th hospital day she began to have polyarthritis, erythema and pain of the tendo achillis. Antistreptolysin O and antistrepto-kinase were elevated and she was diagnosed as having acute rheumatic fever. Coronary angiographic and electrophysiological studies, performed on the 22nd hospital day, demonstrated coronary arteries and sinus node function were normal. When carditis is suspected and the serum emzyme levels of cardiac muscle are normal, acute rheumatic fever should be considered.