日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 32(5): 423-428 (2016)
doi:10.9794/jspccs.32.423

症例報告Case Report

病理組織診断でリウマチ熱による伝導路障害が死因であると疑われた1例Possible Fatal Atrioventricular Block Associated with Acute Rheumatic Fever Diagnosed by Pathological Findings: A Case Report

1岡崎市民病院小児科Department of Pediatrics, Okazaki City Hospital ◇ Aichi, Japan

2岡崎市民病院病理診断科Department of Pathology, Okazaki City Hospital ◇ Aichi, Japan

3中部大学健康生命科学部スポーツ保健医療学科Department of Lifelong Sports for Health, Collage of Life and Health Sciences, 
Chubu University ◇ Aichi, Japan

4名古屋大学医学部付属病院小児科Department of Pediatrics, Nagoya University Hospital ◇ Aichi, Japan

受付日:2016年2月20日Received: February 20, 2016
受理日:2016年6月22日Accepted: June 22, 2016
発行日:2016年9月1日Published: September 1, 2016
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リウマチ熱に伴う極めて稀な突然死症例を経験した.12歳男児.心肺停止で来院したが,蘇生には成功しなかった.剖検の病理診断で,心組織の様々な部位にリウマチ熱に特徴的なAschoff体を認め,房室結節周囲に著明な炎症所見を認めたため,リウマチ熱による伝導路障害が死因であると推定された.リウマチ熱は発展途上国ではいまだによく見られる疾患であるが,日本小児循環器学会の稀少疾患サーベイランスで年間4~10例と,本邦では稀な疾患である.しかしながら,発熱症例に対する過剰な抗菌薬投与が見直されている現在では,発熱性疾患の鑑別においてリウマチ熱の存在を念頭に置くことも忘れてはならないであろう.

We report a rare case of sudden cardiac death associated with acute rheumatic fever (ARF). The patient was a 12-year-old boy referred to our hospital because of sudden cardiopulmonary arrest. Resuscitation failed and autopsy was performed. Pathological findings revealed diffuse pancarditis, which was prominent in the conduction systems, particularly around the atrioventricular node and disseminated Aschoff bodies in various parts, including the valves, myocardium, and endocardium. These findings strongly suggested that his death was caused by atrioventricular block associated with ARF. Although ARF is a common disease in developing countries, it is rare in Japan, with the reported annual incidence of 4–10 cases a year. ARF should be considered in the differential diagnosis of febrile illnesses, particularly in the era when routine antibiotic administration is not recommended.

Key words: rheumatic fever; sudden death; pathology; conduction disturbance

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