脾臓破裂と血栓性微小血管症を合併した悪性高血圧症の1例．症例報告

A rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy: A case report.

• JiaXiang Ding
• Zhen Qu
• Feng Yu

抄録

はじめに:

血栓性微小血管症（TMA）は，悪性高血圧症（MHT）をはじめとする様々な原因により，内皮の損傷に続いて標的臓器に多数の微小血栓が形成されることを特徴とする．ここでは、脾臓TMAの変化を伴うMHTの稀な症例を報告した。

INTRODUCTION: Thrombotic microangiopathy (TMA) is characterized by endothelial injury followed by formation of multiple microthrombi in the target organs due to various causes, including malignant hypertension (MHT). Here, we reported a rare case of MHT with splenic TMA changes.

症例の問題点:

高血圧と蛋白尿の既往歴を有する27歳の漢民族男性が，MHTと血小板減少症を伴う腎不全で当院に入院した．

CASE CONCERNS: A 27-year-old Chinese Han male with a history of hypertension and proteinuria, admitted to our hospital because of renal failure with MHT and thrombocytopenia.

診断:

本症例はMHTと血小板減少症からTMAと診断された．最終的な診断は脾臓病理所見で確定し、他の鑑別診断は除外された。

DIAGNOSIS: This case diagnosed with TMA based on the patient's MHT and thrombocytopenia. The patient final diagnosis was confirmed by the spleen pathological findings, other differential diagnoses were ruled out.

介入:

血液透析と降圧剤の静脈内投与を行い、徐々に病状が改善していった。しかし，入院3日目に突然腹痛を訴え，脾臓自然破裂による出血性ショック状態に陥った。脾臓摘出後の病理所見では脾性TMAを認めた。

INTERVENTIONS: The patient was treated with hemodialysis and intravenous antihypertensive agents, and his condition gradually improved. However, he suddenly complained of abdominal pain and went into hemorrhagic shock, which was due to spontaneous spleen rupture on the third day of hospitalization. The pathological evidence after splenectomy showed splenic TMA.

アウトカム:

血液透析は継続され，退院まで血圧はコントロールされていた．

OUTCOMES: Hemodialysis was continued and the blood pressure was under control until his discharge from our hospital.

結論:

自然発生的な脾臓破裂はMHT誘発性TMAに伴うまれな重篤な合併症であり，臨床的に注意が必要である．

CONCLUSION: Spontaneous splenic rupture could be a rare and critical complication associated with MHT-induced TMA, and it requires careful clinical attention.