回腸終末部から右側結腸にかけて病変がみられた腸チフスの1例

Typhoid Fever Mainly Affecting the Right-Side Colon, Report of a Case

要旨　患者は33歳，男性．海外渡航歴はない．主訴は腹痛，下痢，発熱．入院時，右側腹部に中等度の圧痛あり．末梢血で好酸球消失と肝機能障害を認め，大腸内視鏡検査で回腸終末部から右側結腸にかけ，浮腫および頂部にびらんを有する小隆起を主体とした腸炎を認めた．腸粘膜の生検培養でSalmonella typhiが検出され腸チフスと診断．ofloxacin（800mg/日）の内服治療開始後，速やかに症状と肝障害は改善した．抗菌剤中止後も排菌のないことを確認し退院．約1年後に施行した大腸内視鏡検査では，回腸終末部から上行結腸にリンパ濾胞の過形成が目立つ以外には異常を認めなかった．

　A 33-year-old male was admitted because of fever, diarrhea, and abdominal pain. He had never been to foreign countries. The differential count of white blood cells showed disappearance of eosinophil. The abdominal ultrasonography demonstrated extensive wallthickening mainly of the right-side colon and mild splenomegaly. Barium enema and colonoscopy revealed edema and multiple elevated lesions with small shallow ulcers from the terminal ileum to the proximal transverse colon. A culture of the biopsy specimen was positive for Salmonella typhi, and comfirmed a diagnosis of typhoid fever. He was treated with oral neuquinoron (OFLX 800 mg/day) successfully. Follow-up colonoscopic examination performed one year later showed only multiple lymphoid hyperplasia.