肝膿瘍を併発したエルシニア腸炎の1例

Colitis Caused by Yersinia Enterocolitica in Association with Hepatic Abscess, Report of a Case

要旨　患者は64歳，女性．右下腹部痛を主訴に近医を受診し，注腸X線充満像で上行結腸の進行癌疑いとして紹介された．入院後の内視鏡検査で，上行結腸に多発する不整な浅い潰瘍を伴う狭窄像を認めた．同部からの生検では，非特異的な炎症像を示すのみで，腫瘍細胞はみられなかった．注腸X線検査では，終末回腸の伸展不良と小潰瘍およびBauhin弁の腫大もみられた．第3病日より発熱がみられ，第9病日のCTおよび超音波検査で，肝内に3か所の膿瘍を認めた．膿汁の培養で，Yersinia enterocoliticaが検出された．抗生物質投与により，臨床症状および血液検査データは改善し，大腸病変は潰瘍瘢痕を残して治癒し，肝膿瘍も消失した．便培養では，病原菌は検出されず，血清抗体価の上昇もみられなかったが，臨床経過から，エルシニア腸炎に肝膿瘍を併発したまれな症例と考えられた．

　A 64-year-old woman visited a clinic with right lower abdominal pain as her chief complaint late in November, 1995. By barium enema examination she was diagnosed as having an advanced cancer of the ascending colon. She was admitted into our hospital on November 16, 1995 to be operated on. On admission, her temperature was within normal range, but her white blood cell count was 10,200/mm³ and C-reactive protein was 6.1mg/dl. Double contrast colonography and endoscopy at our hospital demonstrated multiple shallow and irregular ulcers of the terminal ileum and ascending colon, and segmental stenotic change in the proximal portion of the ascending colon. Biopsy specimens from these lesions showed no tumor but non-specific colitis. Her temperature rose daily as high as 38.5 degrees from the third hospital day. Computed tomography and ultrasonography, performed on the nineth hospital day demonstrated three abscesses in the liver. Yersinia enterocolitica was detected in the pus aspirated from one of the abscesses. Cultures of the feces were negative for Yersinia enterocolitica and its pathogens, Chemotherapy with antibiotics was administered, resulting in the improvement of her clinical symptoms and laboratory data. The multiple ulcers of the ascending colon as well as the hepatic abscesses also disappeared. We thought this case to be a very rare one of colitis caused by Yersinia enterocolitica in association with hepatic abscess.