梅毒性直腸炎が疑われたHIV感染症の1例

Suspect Syphilitic Proctitis, Report of a Case

要旨　患者は48歳，男性．主訴は排便時出血．大腸X線検査で，直腸の前～後壁に粘膜集中を伴う多発性地図状潰瘍を認めた，病変の形態と分布，梅毒定性反応（PRPカードテスト，TPHA）陽性，経過中に出現した小紅斑状皮疹などより梅毒性直腸炎を疑ったが，直腸生検材料でのTreponema Pallidumの証明はなされなかった．しかしながら，sexually transmitted disease（STD）の可能性を念頭に置きHIV検査を施行したところ，EIA法，WB法とも陽性が確認された．診断と治療を兼ねた駆梅療法にて，潰瘍病変の速やかな治癒を確認したことで，本症はHIV感染症患者に併発した梅毒性直腸炎と考えられた．

　The patient was a 48-year-old man. He presented with the chief complaint of melena. Colonoscopic examination and a barium enema x-ray study revealed multiple map-like ulcers in the area extending from the anal canal to the upper rectum. Examination of a biopsy tissue specimen failed to demonstrate Treponema pallidum, but a suspicion of syphilitic Proctitis was entertained because of a positive reaction in the serological test for syphilis, the presence of small erythematous eruptions, and the patient's habitual anal coitus. As he tested positive for HIV by both the EIA method and WB method, infection with HIV was confirmed. After initiation of amoxicillin treatment, rapid healing of the rectal lesions was confirmed by endoscopy. Taken altogether, a definitive diagnosis of syphilitic Proctitis was made.