リンパ球性食道炎

Lymphocytic Esophagitis

要旨●患者は70歳代，男性．主訴は慢性的な軽度のつかえ感．過去に食道カンジダ症と診断されていたが，病理組織学的評価は行われていなかった．精査のためEGDを施行したところ，食道に散在する白色滲出物を認めた．生検にて乳頭周囲上皮内にリンパ球浸潤を30個/HPF以上認め，細胞間浮腫を認めた．好中球・好酸球浸潤は目立たず，リンパ球性食道炎と診断した．浸潤するリンパ球はCD3陽性，CD20陰性で，CD4陽性リンパ球がCD8陽性リンパ球に比して優位に浸潤していた．本症は内視鏡所見・病理組織学的所見上，食道カンジダ症，好酸球性食道炎，胃食道逆流症との鑑別を要するが，組織学的所見については議論も多い．リンパ球性食道炎は本邦ではいまだ認知度が低い疾患であり，国際的な診断基準・治療指針の確立が望まれる．

　A man in his 70s with a history of histopathologically unconfirmed esophageal candidiasis presented with persistent mild dysphagia. Esophagogastroduodenoscopy was performed to investigate further. Endoscopic examination revealed scattered white plaques throughout the esophagus. Biopsy results showed peripapillary lymphocytic infiltration and intraepithelial lymphocyte infiltration（30 cells/high-power field）, with no significant neutrophilic or eosinophilic infiltration observed. These findings confirmed the diagnosis of lymphocytic esophagitis. Immunohistochemical analysis showed infiltrating lymphocytes with CD3 immunopositivity and CD20 immunonegativity and a predominance of CD4＋ lymphocytes. Lymphocytic esophagitis must be differentiated from esophageal candidiasis, eosinophilic esophagitis, and gastroesophageal reflux disease based on both endoscopic and histopathological findings. However, the histological features of lymphocytic esophagitis remain controversial. This condition is unrecognized in Japan, highlighting the urgent need for established diagnostic criteria.