薬剤性アフタ性大腸炎の1例

Drug-induced Aphthoid Colitis, Report of a Case

要旨　患者は39歳の女性で，主訴は下痢．1990年12月発熱，咳噺が出現し，解熱鎮痛剤などの投与を受けたが症状が改善せず，4日間抗生剤の投与を受けた．症状は改善したが，2週間後より下痢が出現したため，紹介入院となった．入院時の内視鏡像で下行結腸に多発散在性にアフタ様びらんを認め，一部縦走方向に並んでいた．注腸X線像では下行結腸に多発散在性にbariu fleck，transverse ridging，管状狭小がみられ，横行結腸脾彎曲側のhaustraの消失を，下行結腸下部には縦走潰瘍瘢痕を認めた．以上，アフタ様びらん以外にも病変の既往が示唆され，びらんは，薬剤による腸管の虚血性変化の後の生体反応である可能性が考えられた．

　A 39-year-old female was admitted to our hospital for mucous diarrhea. Two weeks prior to this admission, she developed fever and cough which was not improved by a non-steroidal antiinflammatory drug. She was given a 4 day course of antibiotics for her symptoms. Diarrhea started 2 weeks after administration of antibiotlcs. Colonoscopic examinatlon at admission showed numerous aphthoid lesions surrounded by erythematous areas in the descending colon. There were no lesions in the ascending colon and the rectum. Some of the aphthoid lesions in the descending colon were arranged along a longitudinal axis. Biopsy specimen obtained from aphthoid lesions revealed erosions over lymphoid follicle in the submucosa and edema in the surrounded area. Barium enema revealed disappearance of haustrations at the splenic flexure, and narrowing of the lumen and numerous barium flecks in the descending colon. There were many barium flecks in the sigmoid colon and a scar of a linear ulcer at the anal end of descending colon. These findings suggest that these aphthous lesions were the secondary reactions to ischemic changes of the colon.