発作性夜間血色素尿症の患者にみられた広範・多彩な消化管病変

Extensive, Various Lesions of the Sigmoid Colon in a Paroxysmal Nocturnal Hemoglobinuria Patient, Report of a Case

要旨　患者は32歳，男性．発作性夜間血色素尿症で当院血液内科に通院中．今回，右下腹部痛を主訴として入院した．注腸X線検査にて回腸終末部に狭窄性病変を，上部消化管内視鏡検査にて十二指腸に大きな潰瘍性病変を認め，いずれも虚血性変化と考えられた．経過中施行したコロノスコピーでは，S状結腸に発赤の強いアフタ様びらんが観察された．便中よりClostrdium Difficile toxinが検出され，これとの関連が類推された．

　A 32-year-old man with paroxysmal nocturnal hemoglobinuria who had been followed in our hematologic clinic, was admitted to our hospital because of right lower abdominal pain. Barium enema disclosed a stenotic lesion in the terminal ileum, and upper GI endoscopic examination showed a large ulcerative lesion in the duodenum. These lesions were thought to be secondary reactions to ischemic changes. Follow-up colonoscopic examination revealed aphthoid erosions with severe erythema in the sigmoid colon. Clostridium defficile toxin being detected in his stool was supposed to have relation to these lesions.