非腫瘍性びまん性十二指腸病変の診断―糞線虫症のX線，内視鏡所見を中心に

Duodenal Manifestations of Infectious Diseases

要旨　十二指腸の非腫瘍性びまん性病変を呈する感染症，すなわち糞線虫症，結核，非定型抗酸菌症，サイトメガロウイルス感染症，ランブル鞭毛虫症，イソスポーラ症などについて述べた．これらは日和見感染症として発症することが多い．特に，当科で経験した重症糞線虫症のX線・内視鏡所見については詳細に述べた．X線所見では，粘膜ひだの消失，管腔の拡張や鉛管状狭小化を認めた．内視鏡では，白色絨毛，びらん，発赤，浮腫・混濁，潰瘍の所見を認めた．内視鏡下生検では粘膜内に虫体を証明しえた．免疫不全患者に消化器症状が生じた際は，感染症の可能性を考えて積極的な消化管検索と頻回の糞便検査を行うべきである．

　We described duodenal manifestations of infectious diseases, including strongyloidiasis, tuberculosis, Cytomegalovirus infection, and giardiasis. These disorders usually present in immunosuppressive states associated with malignancy, organ transplantation, acquired immunodeficiency syndrome, and during administration of steroids. We reviewed cases with severe strongyloidiasis. Radiographic studies reveal disappearance of the mucosal folds, dilatation of the lumen, and “lead pipe”-like narrowing in the duodenum and jejunum. Duodenoscopy shows white villi, mucosal edema, erosions, and ulceration with histological identification of Strongyloides stercoralis larvae in the involved mucosa. In addition, we empathized repeated examination of stool samples when immunocompromised patients have various gastrointestinal symptoms.