慢性関節リウマチに続発した消化管アミロイドーシスの1例

Gastrointestinal Amyloidosis Secondary to Rheumatoid Arthritis, Report of a Case

主旨　患者は66歳の女性で，主訴は6か月前から下痢と腹痛であった．9年前に発症した慢性関節リウマチに罹患した．小腸X線検査で腸管がやや収縮したときにびまん性に小透亮像をはっきりと認めた．このように収縮した状態のX線所見が特徴的であった．大腸X線検査でも粘膜は粗糙で網の目像は消失し，一部にニッシェ像を認めた．胃の内視鏡検査で散在性に粘膜の発赤をみた．大腸内視鏡検査で直腸にびまん性の発赤をみた．通常観察で胃・大腸の正常部でも生検で組織学的にAA型のアミロイドの沈着を認めた．

　A case presented here is a 66-year-old woman with gastrointestinal amyloidosis, who has been suffering from rheumatoid arthritis for the past nine years. She complained of diarrhea and abdominal pain. Diffuse granular mucosal pattern was demonstrated in the jejunum on double contrast study. Coarse mucosal pattern with disappeared fine network pattern was demonstrated in the colon on double contrast barium enema. Scattered red spots on gastric mucosa and diffuse redness of rectal mucosa were shown by endoscopy. Biopsy specimens of the stomach and rectum were positive for amyloid deposition which was shown as red homogenous substance in the propria mucosa.