早期梅毒性肝炎を合併した梅毒性直腸炎の1例

Syphilitic Proctitis with Early Syphilitic Hepatitis, Report of a Case

要旨　患者は59歳，男性．1997年5月肛門痛が出現し近医を受診，直腸癌疑いにて当院紹介となった．入院時検査では軽度の炎症反応と肝機能異常を認め，大腸内視鏡検査にて歯状線口側の左側前壁に周堤隆起を伴う，不整形だが辺縁は比較的明瞭な易出血性の潰瘍を認めた．組織診断の結果では悪性細胞は認めず，好中球，形質細胞の浸潤の著しい出血を伴う炎症性病変が主体であった．3回の組織診を施行するも結果は同様であった．梅毒血清反応が強腸性のためbenzyl-penicillin benzathineによる治療を開始，肝機能障害および直腸潰瘍の改善を認めた．梅毒性直腸炎に早期梅毒性肝炎を合併した1例と考えられ，検索した限りでは本邦報告2例目であった．

　A 59-year-old male was admitted to our hospital complaining of anal pain. A hard uneven mass was felt in the 3 o'clock position on digital examination. Laboratory tests showed slightly elevated serum transamilase, bilirubin and a high level of alcaline phosphatase. A positive serological test result for syphilis was noted. Colonoscopy revealed an irregular-shaped ulcerative lesion just above the dental line, which was especially suggestive of rectal cancer. However, in spite of repeated microscopic examinations of endoscopic biopsy specimens taken from the ulcer edge, inflammatory infiltration consisting primarily of plasma cell was revealed, but no malignant cells were comfirmed. After penicillin therapy, the rectal lesion disappeard and results of liver function tests normalized completely and serological findings of syphilis revealed remarkable improvement. Although no Treponema pallidum was shown on microscopic examination, the diagnosis of syphilitic proctitis in this case was convincing because of the evidence above mentioned. Syphilitic proctitis with early syphilitic hepatitis has been thought to be rare. Only two cases have been reported in Japan so far.