2）サイトメガロウィルス感染症

Gastrointestinal Cytomegalovirus Infection

要旨　消化管は，サイトメガロウィルス（CMV）感染症の好発臓器の1つである．従来，打ち抜き潰瘍がCMV消化管病変に特徴的な所見とされてきたが，自験例では食道から直腸まで大小様々な形態の潰瘍を呈し，多彩な病変が多発することが特徴と考えられた．CMVによる消化管感染症の診断は，生検で核内封入体を証明することでなされるが，治療方針の選択にはその他の検査を組み合わせて総合的に判断する必要がある．今後，臓器移植や骨髄移植，強力な化学療法の普及等に伴い，CMVによる消化管病変の増加が予測され，免疫能が低下している宿主においては常に本症を念頭に置いた検査が必要である．

　The gastrointestinal (GI) tract is one of the common sites of cytomegalovirus (CMV) infection. Endoscopically a punched-out ulceration has been considered a characteristic feature of CMV involvement of the GI tract. In our cases, GI tract lesions of CMV were found as ulcerations of various sizes, ranging from aphthoid erosion to extensive ulceration in all parts of the GI tract. Therefore, we consider the multifocal existence of various ulcerations to be a characteristic finding of this infection. For the diagnosis of CMV infection of the GI tract, it is very important to detect cytomegalic inclusion of tissue obtained at biopsy. For the confirmation of CMV infection, combination of the histological method with other methods such as the detection of antigenemia or CMV-DNA from blood is useful. With an increase in immunocompromised patients after transplantation or chemotherapy, there will be an increase in patients infected with CMV. Therefore, it is necessary to be endoscopically on the lookout for CMV infection in immunocompromised hosts.