多発性粟粒大隆起を結腸の広範囲に認めた無症候性腸結核の1例

Asymptomatic Intestinal Tuberculosis with Multiple Mucosal Nodules of the Colon, Report of a Case

要旨　症例は57歳，男性．人間ドックで胸部X線の異常陰影と便潜血陽性を指摘されたため，諸検査を施行した．大腸内視鏡検査では回腸末端に小潰瘍が多発し，上行結腸から下行結腸の広範囲に粘膜下腫瘍様の粟粒大隆起が多発していた．1か月後に再度施行した大腸内視鏡検査では，前回の粟粒大隆起が増加し癒合傾向がみられ，生検にて乾酪性肉芽腫が確認された．さらに，喀痰，胃液，糞便の培養検査で結核菌が検出されたため，肺結核および続発性腸結核と診断した．3剤併用療法を開始し，3か月後には大腸病変は萎縮瘢痕帯へと推移した．一般に，活動性腸結核では種々の進展時期の病変が多中心性に混在して認められるのに対し，自験例は初期病変が広範囲に多発して認められた点が特徴的であった．

　A 57-year-old man was admitted to our hospital because of abnormal shadows on the chest X-ray file and positive fecal occult blood test. Chest CT showed a nodule in the left upper lobe. Colonoscopy showed multiple small open ulcers in the terminal ileum and multiple mucosal nodules predominantly in the left side of the colon. Repeated colonoscopy performed one month later showed that the mucosal nodules had increased and fused. Biopsy specimens from terminal ileum and the ascending colon contained caseous granulomas. Tubercle bacillus were later isolated by the culture of several specimens. Based on these findings, we diagnosed the case as intestinal tuberculosis complicated by pulmonary tuberculosis. After the administration of triple concurrent therapy of anti-tubercular medications for three months, multiple mucosal nodules had disappeared and colonic mucosal lesions had changed into atrophic mucosal areas.