上行結腸に母指圧痕像を認めた病原大腸菌腸炎の1例

Escherichia coli 028ac: H-Associated Colitis with Thumbprinting Sign in the Ascending Colon, Report of a Case

要旨　患者は20歳，男性．発熱，腹痛，下血，嘔吐を主訴に入院．検査成績では，白血球数増多，血沈軽度亢進，CRP陽性を認めた．第4病日に施行した注腸造影で，上行結腸中央部から盲腸にかけて，母指圧痕像と不整形の小バリウム斑の多発がみられ，第7病日の大腸内視鏡検査においても同部の浮腫，発赤と多発する小潰瘍および脆弱な粘膜を認めた．腹部超音波検査では，上行結腸の壁肥厚と回盲部周囲のリンパ節腫大がみられた．便培養で病原大腸菌（組織侵入性，EIEC）が検出され，臨床経過と合わせて，病原大腸菌腸炎と診断した．抗生物質を使用することなく，約2週間で症状・検査成績とも改善し，注腸造影・腹部超音波検査でも炎症像は消失した．

　A 20-year-old man was admitted to our hospital because of fever, abdominal pain, melena, and vomiting. Laboratory data indicated acute inflammation. On the radiography using barium enema, thumbprinting sign was seen in the ascending colon and cecum. Colonoscopic examination revealed edema and small ulcers. Abdominal echography showed thickening of the bowel wall and swelling of lymph nodes around the cecum. A stool culture was positive for Escherichia coli O28ac: H-(EIEC). Subjective symptoms and laboratory data showed improvement without antibiotics. Follow-up barium enema and abdominal echography showed a return to normal. The clinical, radiographic and endoscopic findings simulated those found in ischemic colitis. Abdominal echography and stool cultures were considered to be essential for differential diagnosis of this disease.