Tomohiro Nishio 1, Takuzo Nanbu 2, Toshiyuki Tsujioka 3, Masahiro Yamamoto 3, Masao Nakagawa 4, Hiroyuki Sugihara 5
1 Junior resident, Koka Public hospital
2 Department of Internal Medicine, Koka Public hospital
3 Department of Central Clinical Laboratory, Koka Public hospital
4 Nakagawa Medical Clinic
5 Department of Pathology, Shiga University of Medical Science
The patient, who was a male in his 70s, had a history of acute myocardial infarction and had undergone a defunctioning stoma for Crohn’s disease about ten years ago. He had been in therapy for diabetes mellitus for several years. He complained of urinary incontinence, hematuria, and brownish diarrhea .in June, 200X, and blood chemistry revealed elevated levels of CRP and PSA. He was diagnosed as a prostatic cancer and urinary tract infection by diagnostic imaging and a urinalysis. At the end of September, he underwent cystoscopy since sustaining hematuria led to suspect concomitance of a bladder cancer. On his way home, he felt high fever (40°C) and took a bed rest at home. Early in the next morning, he was found dead in the bedroom. Autopsy disclosed fresh thrombosis due to a rupture of an unstable plaque in the anterior descending branch of left coronary artery. The cause of death was thus inferred as fatal arrhythmia due to acute myocardial infarction. The patient had foci of purulent inflammation in multiple organs including kidney (pyelitis) and defunctioning distal colon, and he was in a septic state, whereas Crohn’s disease was found quiescent. We discuss on the trigger of acute myocardial infarction, effectiveness of defunctioning stoma for Crohn’s disease and the cause of inflammation involving multiple organs.
Key words: Crohn’s disease, acute myocardial infarction, prostatic cancer