9）消化管梅毒

Gastrointestinal Syphilis

要旨　消化管梅毒について自験例の形態学的特徴を中心にその臨床像を概説した．病変部位は本邦では胃が最も多く，一般にそのX線・内視鏡像は，胃前庭部に好発する不整な地図状の浅い潰瘍で，浮腫を伴い易出血性を呈する．これに加え，胃梅毒では自験例のような皮膚病変に類似した胃粘膜疹を伴うことがあり，鑑別診断上重要な所見と言える．一方，欧米では同性愛者における直腸梅毒の報告が多いが，本邦ではいまだまれな疾患である．その特徴は辺縁に硬結や隆起を伴う単発または多発性の潰瘍性病変とされるが，自験例の第2期梅毒の大腸の粘膜疹様病変とは異なっている．同性愛者にみられる病変の多くは，肛門性交にて損傷した直腸粘膜に梅毒菌が直接侵入して形成された第1期の原発巣が形態変化したものと考えられる．

　We discuss the clinical features in patients with the gastrointestinal syphilis. The morphologic findings of secondary gastric syphilis are those of multiple irregular, shallow, antral ulcers with associated edema and hemorrhage. In addition, if there are multiple large verruciform lesions which resemble syphilitic skin lesions, in the gastric body, they are valuable for the diagnosis of secondary gastric syphilis. On the other hand, syphilitic proctitis which is one of the common diseases among homosexual men in the United States is rare in Japan. Most of the endoscopic findings reported as single or multiple irregular ulcerated lesions are different from our cases, in which proctoscopy showed a large verruciform lesion coexisting with secondary gastric syphilis. We considered that these reported cases of syphilitic proctitis were not secondary syphilitic lesions but primary lesions caused by proctogenital sexual contact.