非特異性多発性小腸潰瘍に併存したWhipple病の1例

Whipple's Disease accompanied by Nonspecific Multiple Ulcers of the Small Intestine: Report of a Case

　非特異性多発性小腸潰瘍症として，外科的治療を施行した症例の摘出小腸と腸間膜リンパ節の病理組織学的再検討を行なったところ，その組織所見は従来本邦にはほとんどないとされていたWhipple病のそれにほぼ一致することが判明したので報告する．

症例

　患　者：00-00-73，45歳　男

　主　訴：浮腫，貧血，下痢

　A 45-year-old male patient was admitted to Kitasato University Hospital complaining of anemia, edema, and diarrhea in August 1971.

　He had been a known anemic for about 20 years and hypoproteinemia was first diagnosed about 12 years previously. He had a partial gastrectomy because of melena 9 years before. He had been suffering from polyarthralgia and recurrent diarrhea for several years. A gastrointestinal X-ray series disclosed multiple ulcers with circular strictures in the small intestine. Laboratory examinations revealed marked hypoproteinemia (T.P. 3.6g/dl), hypochromic anemia and other malabsorption syndromes.

　In September 1971, one month after his admission, a partial resection of the small intestine was performed. The specimen showed multiple nonspecific ulcers. Postoperatively, his general condition did not improve. In December 1972, he had an emergency operation because of acute peritonitis caused by intestinal perforation. Postoperative course was not eventful, but still his general condition did not show any improvement.

　In September 1974, the specimens of the small intestine resected 3 years previously were re-examined pathohistologically, and it was clarified that the lamina propria of jejunal mucosa and mesenteric lymphnodes were filled with numerous macrophages that contained PAS-positive, diastase-resistent materials. Although we failed to detect so-called bacilleform bodies electronmicroscopically, we thought that the clinical diagnosis could be Whipple's disease, based on the light microscopic histochemical findings as well as on clinical features. Then the patient was subjected to antibiotics treatment (Tetracycline 750 mg daily). About 2 months later, the patient got well symptomatically and the serum protein level improved up to 5.4g/dl.