AIDS患者にみられたcytomegalovirusおよびCryptosporidium混合感染による腸炎の1例

Colitis Due to Cytomegalovirus and Cryptosporidium Infection Associated with AIDS, Report of a Case

要旨　患者は46歳，男性(同性愛者)．1991年ごろから，HIV陽性と診断されていた．1995年7月ごろから下痢が出現し，止痢剤投与によっても改善せず，次第に血液を混じる下痢となったため，精査入院となった．頻回の便の検索(培養など)によっても原因不明のため，大腸検査を施行した．注腸X線検査では全大腸に潰瘍性大腸炎に類似したleadpipe様変化と，横行～S状結腸に多発する打ち抜き様潰瘍を認め，大腸内視鏡検査では，全大腸粘膜に発赤，びらんと注腸X線でみられた深い潰瘍を認めた．潰瘍辺縁部の生検でcytomegalovirusの封入体を，びらん発赤部の生検でCryptosporidiumを認めたため，混合感染による大腸炎と診断した．

　A 46-year-old homosexual man was diagnosed as HIV positive since 1991. Diarrhea occured from July 1995, but stegnotic therapy was non-effective. Gradually he complained bloody stool and was admitted to our hospital. Several stool cultures for ova and parasites were negative. Double contrast barium enema revealed lead-pipe appearance mimicking ulcerative colitis and punched out shaped deep ulcers from the transverse colon to the sigmoid colon. Total colonoscopy demonstrated diffuse pancolitis and punched out shaped ulcers. Biopsy specimen revealed cytomegaloviral inclusion bodies at the edge of ulcers, in addition oocysts of Cryptosporidium in the erosive colonic mucosa and at the edge of ulcers. We considered that these radiographic and endoscopic findings of the colon were caused by mixed infection.