ブレオマイシンが奏効したいわゆる進行性壊疽性鼻炎の1例

THE USE OF BLEOMYCIN IN TREATMENT of RHINITIS GANGRAENOSA PROGRESSIVA

　I．はじめに

　いわゆる進行性壊疽性鼻炎の本態は現在なお不明であり，炎症説，腫瘍説，Virus説，アレルギー説，膠原病説などがある。したがつて，その治療方法も複雑多岐にわたつているが，主な治療方法としては，①放射線療法，②手術，③制癌剤，④ステロイド，⑤抗生剤などがあげられる。北村^5）は，以前は手術と放射線療法がもつとも多かつたが，最近ではステロイドの併用または単独使用が増加していると述べている。われわれは最近，ブレオマィシン（以下BLMと略す）投与により著効をみた，いわゆる進行性壊疽性鼻炎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次第である。

　A man, aged 51, complained of nasal crusting and a complete occlusion of the left nare. With exploratory opening of the left maxillary sinus a diagnosis of malignant reticulosis was made. The results of protein, globulin and blood examination were negative. Kidney function test was negative; the Wegener's granulomatosis was ruled out. The final diagnosis was malignant granuloma.

　The patient was treated by administration of 300mg of bleomycin intravenously. The crusting in the nasal cavity and the abnormal granulation of the sinus cavity disappeared. However, the use of bleomycin alone failed to prevent recurrence of the malignancy; the treatment was supplemented by addition of 3000 r Co⁶⁰ irradiation. Three months later signs of recurrence again appeared in the right side of the nose. The use of bleomycin was resumed only to evoke severe reactions which precluded its further use. The treatment was continued with 2000 r of Co⁶⁰ irradiation.