A case of chronic lymphocytic leukemia associated with nephrotic syndrome

ネフローゼ症候群を合併した慢性リンパ性白血病(以下CLL)の1例を報告する.症例は56歳,男性.昭和61年蛋白尿を指摘され,昭和63年8月より下肢の浮腫,全身倦怠感,盗汗,レイノー現象が出現した.同年11月急性扁桃腺炎を契機にネフローゼ症候群を発症し抗核抗体陽性,抗DNA抗体高値,低補体価よりループス腎炎の疑いにてプレドニゾロン(以下PSL) 30mg/日, dipyridamole 300mg/日投与され,腎生検ではループス腎炎(diffuse proliferative lupus nephritis)に類似の組織学的所見を呈していた.経過中に末梢血リンパ球数(10,560/mm3)の増加と膜表面免疫グロブリン保有細胞(IgM, IgD, κ鎖陽性)が80%を占め,モノクローナルなBリンパ球の増殖が認められた.さらに,骨髄穿刺では同じ表面マーカーを有する成熟小リンパ球が50%を占めCLL (stage 0)と診断した.現在, PSLの投与により蛋白尿の消失,末梢血リンパ球数も減少し,良好な経過をたどっている.

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