健康成人に発症したサイトメガロウイルス関連急性胃粘膜病変の1例

Acute Gastric Mucosal Lesions Associated with Cytomegalovirus Infection in Previously Healthy Adult, Report of a Case

要旨　患者は50歳，男性．発熱，全身倦怠感，心窩部痛，体重減少を主訴に当科紹介入院となった．血液検査では異型リンパ球を伴った白血球上昇と軽度肝機能障害を認めた．上部消化管内視鏡検査では前庭部に浮腫，びらんおよび顆粒状隆起がみられ，胃角から体上部小彎にかけて不整形の浅い潰瘍を認めた．血清学的にcytomegalovirus(CMV)の抗原血症が陽性であったため，CMV感染症と診断した．胃生検組織標本にて封入体細胞が確認され，胃粘膜病変はCMV感染によるものと診断した．CMV感染症は日和見感染として知られているが，本例は健康成人に発症したCMVによる急性胃粘膜病変の1例であり，極めてまれであるため報告した．

　A 50-year-old man with fever and epigastralgia was admitted to our hospital. Laboratory data showed leukocytosis with atypical lymphocytes and slight liver dysfunction. Upper gastrointestinal endoscopic study revealed a mixture of edema, erosion and granular elevated mucosa in the antrum. In addition, an irregular shallow ulcer spreading from the angle to the lesser curvature of the upper body was deserved. We diagnosed this as a definite case of cytomegalovirus (CMV) infection, because the antigenomia of CMV was positive serologically. A biopsy specimen taken from the margin and the bed of the ulcer showed intranuclear inclusion bodies, suggesting that acute gastric mucosal lesions (AGML) were associated with CMV infection. Although CMV is an important pathogen in an immunocompromised host, this patient had no detectable immunodeficient condition. We present this rare case reviewing the previous reports of AGML associated with CMV in normal hosts.