十二指腸にびまん性微細隆起病変と回腸盲腸に腸結核の所見を認めcommon variable immunodeficiencyを合併したランブル鞭毛虫症の1例

Duodenal Lesion Caused by Giardiasis Associated with Intestinal Tuberculosis, Report of a Case

要旨　患者は57歳，女性．下痢，下肢の浮腫を主訴に来院．血液検査にて低蛋白血症，低γ‐グロブリン血症がみられた．消化管検査では，十二指腸第2部を中心に球部から上部空腸にびまん性，密在性の微細隆起が認められ，生検にてGiardia lamblia（GL）と診断された．この病変とは別に回腸には輪状潰瘍，萎縮瘢痕帯が，盲腸には短縮と回盲弁の開大，萎縮瘢痕帯が認められ腸結核疑診例と診断した．metronidazoleを投与し自覚症状と低蛋白血症は改善した．十二指腸病変はGL感染の慢性化による変化，回腸病変は結核によるものと診断した．本症例は基礎疾患にcommon variable immunodeficiencyがありGL，結核の重複感染，giardiasisの重篤化による蛋白漏出性胃腸症を呈したものと推測された．

　A 57-year-old woman was admitted to our hospital, complaining of bilateral edema of the legs. Laboratory findings showed hypoprotenemia and hypogammagrobulinemia. Upper gastrointestinal examination revealed multiple slight elevated lesions distributed diffusely from the first portion of the duodenum to the upper portion of the jejunum. A biopsy specimen was taken from the duodenum and, histologically, it was diagnosed as giardiasis.

　In addition, Barium enema showed a circumferential ulcer and atrophic mucosa with multiple ulcer scars in the ileum. Colonoscopic findings revealed a destroyed ileocecal valve and atrophic mucosa with multiple ulcer scars in the cecum. From these lower intestinal manifestations, we suspected intestinal tuberculosis. We started to administer metronidazole, and the symptoms of this patient and hypoprotenemia were improved.

　The duodenal lesion was considered to be caused by chronic infection from Giardia lamblia and the ileocecal lesion was diagnosed as intestinal tuberculosis.