酵素抗体法により胃生検組織中にTreponema pallidumを証明した胃梅毒の1例

Treponema Pallidum Demonstrated in Gastric Biopsy Specimen by Immunohistochemical Technique (ABC Method), Report of a Case

要旨　38歳，男性．心窩部痛にて受診し，胃X線検査，胃内視鏡検査により胃体部から前庭部まで広範な網目状のびらんとその間に胃粘膜が大小不同の類円形を呈して島状に残存する所見を得た．X線所見では前庭部の伸展不良，内視鏡ではびらん面の苔が白色が強く，また送気により出血することが特徴的であった．血清梅毒反応が陽性で，抗潰瘍療法に抵抗し，胃生検で形質細胞浸潤が激しかった．胃生検のパラフィン包埋材料を用いて酵素抗体法を施行し，胃粘膜内にTreponema pallidumを証明し，胃梅毒の確診を得ることができた．胃梅毒の確定診断には感度が高く，容易である本法は広く推奨される．

　A 38-year-old man complaining of epigastralgia underwent endoscopic examination which revealed ulcer and multiple erosions with yellow coating in distal two thirds of the stomach. In despite of one month treatment with cimetidine, his symptom did not improve. Repeated endoscopy showed numerous shallow erosions coated with blood and marked stricture of the antrum. Upper gastrointestinal study showed poorly distended antrum and shallow irregular erosion in the gastric body down to the antrum. A Wassermann test was positive. Microscopic examination of endoscopic biopsy specimens revealed an inflammatory infiltrate consisting primarily of plasma cells surrounding arterioles, walls of which were swollen. Numerous Treponema pallida were demonstrated in formalin-fixed gastric biopsy specimens by immuno-peroxidase technique (ABC method).

　The patient received antilutic therapy consisting ampicillin 4 g/day and 5.0 million units benzylpenicillin for a month followed by doxycycline hydrochloride 200 mg/day orally in the next two months. Antilutic therapy was effective in relieving epigastralgia with endoscopy and barium meal study demonstrating improvement of gastric lesions.

　Immuno-peroxidase technique (ABC method) used in formalin-fixed gastric biopsy specimens is extremely useful and essential for the diagnosis of syphilitic gastropathy.