成人T細胞白血病/リンパ腫に合併したサイトメガロウイルス食道炎の1例

Cytomegalovirus Esophagitis Associated with Adult T-cell Leukemia/Lymphoma, Report of a Case

要旨　患者は79歳，女性．主訴は胸のつかえ感と食思不振．近医の内視鏡検査で食道にやや深めで白苔に覆われた潰瘍が多発していたため当科紹介入院．初回から10日後の内視鏡検査では，食道潰瘍の白苔はほぼ消失し発赤調の陥凹面を呈していた．同X検査でも多発するバリウム斑と皺襞集中像が描出された．食道潰瘍からの生検でhaloを伴う核内封入体および免疫染色でサイトメガロウイルス（CMV）抗原を確認し，CMV食道炎と診断した．末梢血白血球中にもCMV抗原陽性細胞を認めた．また，末梢血中の異常リンパ球，CTでの頸部，鼠径部および傍大動脈リンパ節腫大，HTLV-1抗体陽性が確認された．以上より，成人T細胞白血病/リンパ腫を基礎疾患として発症したCMV食道炎と考えられた．

　A 79-year-old woman was admitted to our hospital because she felt that there was a brockage in her esophagus and had little appetite. Esophagogastroduodenoscopy showed multiple ulcers throughout the esophagus. Barium examination of the esophagus also revealed multiple barium flecks and converging folds. She was diagnosed as having cytomegalovirus (CMV) esophagitis because biopsy specimens from esophageal ulcers demonstrated intranuclear inclusion bodies and immunohistochemical identification of CMV. She was positive for CMV antigenemia. Furthermore, peripheral abnormal lymphocytes, lymphadenopathy, HTLV-I seropositivity were detected. From these data, it is considered that her CMV esophagitis was associated with adult T-cell leukemia/lymphoma.