クラミジア直腸炎の1例および本邦報告6例の検討

Chlamydia Trachomatis Proctitis, Report of a Case and Review of the Literature in Japan

要旨　症例は35歳女性で，3か月間続く下痢を主訴とした．大腸X線検査では直腸に限局するびまん性顆粒状粘膜を認めた．大腸内視鏡検査では直腸に顆粒状小隆起の密在，発赤，びらんを認め，病理組織学的にはリンパ濾胞の増生と炎症細胞浸潤を認めた．血清中のChlamydia trachomatis IgG抗体陽性，直腸擦過診のPCR法でChlamydia trachomatisのDNAを検出したことからクラミジア直腸炎と診断した．塩酸ミノサイクリンによる治療後，症状および直腸病変は軽快した．自験例に加え，これまでに本邦で報告された6例の検討を加えた．著明なリンパ濾胞の増生を伴う直腸炎を診た場合，クラミジア感染を考慮して検索を進めるべきである．

　A 35-year-old woman was referred because of a 3-month history of diarrhea and hematochezia. On admission, physical examination revealed tenderness in the lower abdomen. Laboratory results were significant for a C-reactive protein level of 0.34 mg/dl and an erythrocyte sedimentation rate of 39 mm/hr. IgG antibodies were positive for Chlamydia trachomatis. Colonoscopy and barium enema examination demonstrated numerous nodular lesions spreading over the rectum. The mucosa above the sigmoid colon appeared normal. Rectal-biopsy specimens showed hyperplasia of the lymphoid follicles and diffuse infiltration of inflammatory cells. The DNA of Chlamydia trachomatis was determined from rectal specimens by polymerase chain reaction. The patient was treated with minocycline hydrochloride, after which she became asymptomatic. We reviewed seven cases of Chlamydia trachomatis proctitis in the Japanese literature. We conclude that gastroenterologists should be aware of Chlamydia trachomatis proctitis and include it in the differential diagnosis of inflamed rectal mucosa showing numerous nodular lesions.