胃梅毒の2例―第2期梅毒性皮疹との形態学的類似性について

Gastric Syphilis: Morphologic Resemblance between Gastric Lesions and Skin Manifestations in Secondary Syphilis, Report of Two Cases

要旨　幽門前庭部に梅毒に特徴的と言われている不整な潰瘍性病変を伴う第2期の胃梅毒の2例を経験した．この病変に加えて2例とも胃体部に大型びらん様の特異な胃粘膜斑が多数認められた．同病変の生検組織内に酵素抗体ABC法により梅毒スピロヘータが証明され，駆梅療法によりすみやかに消失したことより，胃体部の病変も梅毒の胃病変と確診された．この胃粘膜斑は，第2期梅毒の皮膚病変に類似しており，形態学的にも梅毒性皮疹の発生と同様の機序が胃粘膜にも生じていると考えられた．

　Two cases of secondary syphilis with gastric lesions are presented. Both had irregular-shaped ulcerative lesions in the antrum, which is considered to be characteristic to gastric syphilis. In addition, they had multiple large verruciform lesions in the gastric body. The presence of Treponema pallidum was confirmed by immunohistochemical staining (ABC method) of biopsy specimens taken from these lesions. Treatment with penicillin led to prompt disappearance of both verruciform and antral lesions.

　Based on these observations, we considered that ulcerative lesions in the antrum and verruciform ones in the body were both gastric manifestations of secondary syphilis.

　Interestingly, large verruciform lesions resembled syphilitic skin lesions. Our speculation is that gastric mucosal changes in secondary syphilis develop by the same pathologic mechanism whereby syphilitic skin lesions develop.