Whipple病の1例

Whipple's Disease, Report of a Case

要旨　症例は52歳，男性．下痢と体重減少を主訴に入院．小腸造影検査ではKerckring皺襞の腫大がみられ，小腸内視鏡検査では十二指腸から上部空腸にかけてびまん性に白色絨毛，粗そう粘膜を認めた．同部の生検病理組織所見でHE染色にて粘膜固有層に多数のfoamy macrophagesがみられ，PAS染色で強陽性であり，電顕にて多数の桿菌がみられた．Tropheryma whipplei DNAをPCRで確認して確定診断した．抗菌薬により症状は改善した．その後ST合剤を内服しているが，15か月後の小腸内視鏡検査でやや浮腫性変化は残存していたものの，白色調粘膜所見は消失していた．

　A 52-year-old man was admitted to our hospital because of diarrhea and weight loss. Radiographic examination of his small intestine revealed edematous mucosa and push enteroscopy showed diffuse yellow-white shaggy mucosa in the duodenum and jejunum. Histological examination of the biopsy specimens stained with hematoxylin and eosin demonstrated massive infiltration within the lamina propria by foamy macrophages strongly positive for periodic acid-Schiff stain. In addition, electron microscopy disclosed numerous bacilli. The definitive diagnosis of Whipple's disease was made because of detection by PCR of Tropheryma whipplei DNA. Antibiotic therapy improved his clinical symptoms. This treatment has been followed by trimetoprim-sulfamethoxazole (TMP-SMX, orally) for the last 15 months. Although slightly edematous mucosa has persisted in enteroscopic findings, diffuse yellow-white shaggy mucosa has improved dramatically.