回腸終末部および大腸全域に病変を呈したパラチフスAの1例

On His Tenth Hospital Day, Blood and Stool Culture Revealed Salmonella paratyphi A, Report of a Case

要旨　症例は20歳代前半，男性．ミャンマー渡航中に発熱と下痢が出現し，発症後14日目に血便と発熱を主訴に当科を受診．血液検査では中等度の炎症反応を認めた．大腸内視鏡検査では，回腸終末部の腸間膜付着対側に卵円形の浅い潰瘍性病変を数か所認めた．また，大腸全域にアフタ様病変がみられ，下行結腸ではこれに加え類円形潰瘍と粘膜浮腫を認めた．生検・便汁培養にてSalmonella paratyiphi Aが検出されパラチフスAと診断し，ニューキノロン製薬投与により改善した．3か月後の大腸内視鏡検査では異常は認めず，生検・糞便培養検査も陰性であった．

　A 25-year-old male, who was febrile for 2 weeks after traveling to Myanmar, was admitted to our hospital because of high grade fever（38～39℃）, and melena. In the physical examination on admission remittent fever and pulse-temperature dissociations were noted. The differential count of white blood cells showed no disappearance of eosinophil. Barium-enema and colonoscopy revealed multiple oval-sharped ulcers on the edematous Peyer's patches in the terminal ileum and apthoid lesions from the caecum to the rectum. The culture of the biopsy specimen from the terminal ileum was positive for Salmonella paratyphi A. Also S. paratyphi A was isolated in the blood. This data led to the confirmation of the diagnosis of paratyphoid fever, the patient was treated with oral neuquinoron successfully. Follow-up colonoscopy performed one year later showed only multiple lymphoid hyperplasia.