バルーン小腸内視鏡が診断に有用であり生物学的製剤にて軽快した消化管GVHDの1例

Diagnostic Usefulness of Balloon Enteroscopy and Therapeutic Efficacy of Biologics for Acute Intestinal GVHD, Report of a Case

要旨　患者は40歳代，男性．急性白血病に対して非血縁者間骨髄移植が施行された．移植後20日より発熱と心窩部痛が出現し，上部消化管内視鏡検査にて胃前庭部は浮腫のみであったが，生検で上皮細胞のアポトーシスが認められ消化管GVHDと診断された．メチルプレドニゾロンを投与するも改善せず，1日10行に及ぶ水様下痢も出現した．また，移植後75日のバルーン小腸内視鏡検査では空腸と回腸に多発性不整形潰瘍と粘膜脱落が認められた．症状はステロイドに加え各種免疫抑制剤にも抵抗性であったため，移植後77日よりインフリキシマブを投与したところ，腹痛と下痢は速やかに軽快した．病態把握に小腸内視鏡は有用であり，インフリキシマブ投与は難治性GVHDに考慮すべきと考えられた．

　A 40-year-old man with acute leukemia received BMT（bone marrow transplantation）. Fever and epigastralgia appeared on the 20th day after BMT and he was diagnosed as having intestinal GVHD（graft-versus-host disease）by the appearance of gastroduodenoscopy and the histological examination of the endoscopic biopsy. Severe watery diarrhea began and turned worse in spite of steroid administration. Balloon enteroscopy on the 75th day after BMT revealed multiple ulcers and mucosal sloughing both in the jejunum and ileum. Because the symptom was resistant to various immunosuppressants as well as steroid, Infliximab was administered on the 77th day after BMT. The epigastralgia and the watery diarrhea improved immediately. It is suggested that balloon enteroscopy is useful for evaluation of intestinal GVHD and Infliximab treatment should be considered for intractable GVHD.