病原性大腸菌O157：H7による出血性腸炎の1例

Hemorrhagic Colitis Caused by Escherichia coil O157: H7, Report of a Case

要旨　患者は54歳，女性，主訴は，粘血下痢便，右下腹部痛，発熱．近医から紹介され当科に入院．入院時著明な炎症反応と注腸造影で上行結腸に拇指圧痕像，大腸内視鏡検査では上行結腸中央部から盲腸にかけて，粘膜の発赤，浮腫，びらんが認められた．便培養により腸管出血性大腸菌であるO157：H7を検出しVero毒素が証明された．以上から病原性大腸菌O157：H7による出血性大腸炎と診断．中心静脈栄養および抗生剤投与で症状，炎症所見は消失した．右側結腸に虚血性大腸炎様所見を認めた場合，本症を常に念頭におき，早期診断，合併症予防を行うことが重要である．

　A 54-year-old female was admitted to our hospital with diarrhea, right lower abdominal pain, fever, melena. The white cell count was 19,600/mm³ and C-reactive protein was 9.9 mg/dl. Barium enema showed thumbprinting sign in the ascending colon. Colonoscopy revealed edematous, and reddish mucosa, and erosions in the ascending colon and cecum. A stool culture was positive for Escherichia coli O157. Thus the patient was diagnosed as having hemorrhagic colitis caused by Escherichia coli O157: H7. Her symptoms and inflammatory parameters improved with antibiotics and intravenous hyperalimentation. When radiographic and endoscopic findings similar to ischemic colitis are found in the right side colon, it is necessary that hemorrhagic colitis should be considered in the differential diagnosis.