粘膜優位型尋常性天疱瘡による食道粘膜剝離の1例

Esophageal Mucosal Abrasion Resulting from Mucosal-Dominant Type of Pemphigus Vulgaris, Report of a Case

要旨　患者は65歳，女性．鮮血吐血にて他院で上部消化管内視鏡検査を施行され，食道粘膜剝離による吐血と診断された．当科にて再検したところ，食道粘膜に異常所見を認めなかったが，生検鉗子にて食道粘膜生検を施行すると，食道粘膜は軟らかく引き伸ばされ，粘膜は広範に剝離した．皮膚病変を認めず，抗デスモグレイン（Dsg）1抗体が正常範囲内で，抗Dsg3抗体が高値を示していたため，粘膜優位型尋常性天疱瘡による食道粘膜剝離と診断し，ステロイド治療にて症状は改善した．

　This case is that of a female patient aged 65. Due to hematemesis, upper gastrointestinal endoscopy had been performed at another hospital, and a diagnosis of hematemesis resulting from esophageal mucosal abrasion was reached. When the subject was re-examined at our hospital, no abnormal findings were observed in the esophageal mucosa ; however, when an esophageal mucosal biopsy was performed with biopsy forceps, the esophageal mucosa was loosely stretched, and the mucosa became detached, over a wide range. No skin lesions were observed, anti-desmoglein（Dsg）1 antibodies remained within the normal range, and anti-Dsg3 antibodies were in a high range, so the diagnoses was esophageal mucosal abrasion resulting from mucosal-dominant type of pemphigus vulgaris, and the symptoms improved with steroid therapy.