シスプラチン，エトポシド，ブレオマイシンの併用化学療法中に発症した急性心筋梗塞の1例

A Case of Acute Myocardial Infarction after Bleomycin, Etoposide and Cisplatin Chemotherapy

要旨　患者は34歳，男性．左精巣腫瘍で泌尿器科に入院．左精巣摘出術後cisplatin，etoposide，bleomycinの併用化学療法を施行していた．化学療法2コース目開始8日後に突然前胸部痛を訴え，心電図でII，III，aVF，V_1〜6でST上昇を認めた．緊急冠動脈造影で左前下行枝seg．6の最近位部に冠動脈内をほぼ閉塞する球状血栓，seg．8の遠位部に完全閉塞を認めたが，PTCAにより血栓は消失した．本例は34歳と若年で冠動脈疾患の既往はなく，喫煙以外の冠危険因子を認めず，また先天性，後天性の血栓性素因を認めなかったため心筋梗塞は抗癌化学療法が原因と考えた．その後，再発予防のためにwarfarin，aspirin，diltiazem投与下に化学療法を2コース追加し完全寛解を得た．退院前に冠動脈造影，左室造影を行ったが異常は認めなかった．抗癌化学療法に伴う急性心筋梗塞の発症は極めて稀で，心筋梗塞の原因で閉塞性血栓が証明された報告はこれまでになく，貴重な症例と考えられた．

　A 34-year-old man was admitted to our hospital for left testicular cancer. After left-sided orchiectomv. he was treated with conventional doses of cisplatin, etoposide and bleomycin (PEE). On day 8 of the secondchemotherapy course, he complained of chest pain. An electrocardiogram showed ST segment elevation in II, III, aVF and V_1~6. He had had no previous history of coronary artery disease and his only known risk factor was smoking. Emergent coronary angiography revealed subtotal occlusion of the immediately proximal portion of the left anterior descending artery (LAD) due to a spherical thrombus and total occlusion of the distal LAD. The immediately proximal lesion was successfully dilated with PTCA and the thrombus disappeared. The peak creatinine phosphokinase (CPK) was 739 IU/l. Anticoagulant, antiplatelet therapy and diltiazem was begun in order to prevent thrombosis and vasospasm. After an additional two course of chemotherapy, the patient enjoyed complete remission. Follow-up coronary angiography revealed normal coronary artery and a left ventriculogram showed normal contraction. The patient has. so far, suffered no recurrence of coronary events or any other thrombotic episodes.

We believe that this is the first case-report of an intracoronary obstructing thrombus involved in acute myocardial infarction caused by antineoplastic therapy.