IgG4関連冠動脈周囲炎に対する低用量ステロイド治療中に冠動脈破綻をきたした1例

A case of coronary artery disruption during low–dose steroid treatment of IgG4–related coronary periarteritis

IgG4関連疾患においては，炎症性腹部大動脈瘤など大動脈周囲炎との関与が知られているが，中型動脈である冠動脈にも動脈周囲炎をきたす^1）。冠動脈周囲炎は狭窄型，動脈瘤型，びまん性壁肥厚型に分類され^2），心筋梗塞や動脈瘤破裂などの致死的合併症を引き起こすおそれがあるため，早期診断や適切な管理が重要である。今回我々は，IgG4関連冠動脈周囲炎に対する低用量ステロイド治療中に生じた冠動脈破綻に対してステント留置を施行した症例を経験したため報告する。

IgG4–related diseases has been known to cause coronary arterial stenosis, aneurysms, and even disruptions, but there is no consensus on therapeutic strategy. We report a case of coronary artery disruption during steroid treatment of IgG4–related coronary periarteritis, which was treated with coronary artery covered stenting. A 74–year–old male on steroid therapy for IgG4–related periarteritis represented shortness of breath. Coronary computed tomography and angiography showed right coronary aneurysms. The patient underwent intravascular treatment with covered stents to avoid the risk of postoperative infection. While the coronary artery was unstable, the aneurysms were successfully covered. Follow–up CT showed no evidence of the coronary aneurysms re–dilatation. Intravascular treatment with covered stents can be a treatment option for coronary artery disruption due to IgG4–related periarteritis, while careful follow–up is necessary.