AIDS患者にみられる消化管病変

Clinicopathological Study of the Gastrointestinal Lesions of Japanese AIDS Patients

要旨　AIDS患者剖検例51例を対象とし，その消化管病変に関して臨床病理学的検討を行った．サイトメガロウイルス感染は18例にみられ，食道潰瘍，胃びらん，胃潰瘍，小腸炎，回盲部潰瘍，大腸炎および潰瘍などを形成した．病理学的に上皮細胞，小血管内皮細胞への感染のほか，筋間神経叢や平滑筋への感染による筋層壊死がみられた．単純ヘルペスウイルス感染は4例で陰部潰瘍としてみられた．Mycobacterium avium-intracellulareの消化管感染は4例にみられ，全例他臓器への撒布性感染を伴っていた．3例で便から同菌を分離した．肉眼的に小腸粘膜が一様に厚く表面が白色の微細顆粒状を呈するものと，結節状小隆起が散在するものとがあった．カンジダ症は最も頻繁にみられ口内炎，食道炎が多いが，大部分が治療により治癒軽減していた．クリプトスポリジウム感染は1例のみ認め，持続する水様下痢を主症状とした．カポシ肉腫は8例で消化管病変を形成し，皮膚もしくは口腔内病変を伴っていた．1例は持続する消化管出血のため重度の貧血に陥っていた．

　I studied gastrointestinal lesions in 51 autopsy cases of acquired immunodeficiency syndrome from a clinicopathological viewpoint. Cytomegalovirus infection existed in 17 cases as esophageal ulcers, gastric erosion ＆ ulcers, enterocolitis ＆ ulcers. Microscopically, cytomegalic inclusions were found within not only the epithelium and endothelium but also within the intermuscular plexus and proper muscle cells presenting as necrosis. Mycobacterium avium-intracellulare had infected intestines in four cases and was always accompanied with dissemination. Acid-fast bacilli were isolated from stools in three cases. Macroscopically, the infected enteric mucosa showed thick and finely granular patterns or scattered tuberculous patterns. Candidiasis was the most commonly found complication in the course of AIDS and caused oroesophagitis, but in many cases it was reduced or cured at autopsy. Cryptosporidiosis was detected in one case, presenting as severe watery diarrhea. Kaposi's sarcomas ordinarily formed skin or oral lesions and accompanied gastrointestinal lesions in eight cases. Their intestinal manifestations were usualy mild but sometimes they caused severe bleeding as shown in one case.