抗生物質が原因と考えられる急性出血性大腸炎の臨床像

Clinical Features of Acute Hemorrhagic Colitis Related to Antibiotics

　過去3年間に，抗生物質が原因と考えられる急性出血性大腸炎17例を経験した．そのうち3例の臨床所見および経過について報告し，若干の検討結果についても言及する．

　The clinical, endoscopic, radiologic and histologic features of 17 cases hospitalized with acute hemorrhagic colitis related to antibiotics were presented for this three years. Three cases of them were reported.

　Case 1: A 30-year-old woman presented abdominal cramps and bloody diarrhea. She had been treated for possible postoperative infection with oral amoxicillin 250 mg four times daily for seven days before admission. Physical examination was normal except slightly abdominal tenderness. Colonoscopy showed edematous, diffusely hyperemic and bloody mucosa, and other parts were normal. Biopsy revealed edema, inflammatory cells, acute erosions and hemorrhage in the lamina propria. Barium enema showed marked spasm, thickened interhaustral folds and thumbprinting appearance from splenic flexure to ascending colon. The patient was given intravenous fluid. When the patient was discharged on the eighth hospital day she was free from symptom.

　Case 2: A 28-year-old woman presented with abdominal pain and frequently bloody diarrhea. She had been treated for tonsillitis with oral ampicillin 250 mg four times daily for twelve days before admission. Physical examination was severe abdominal tenderness. Colonoscopy showed almost the same findings as case 1 except discrete yellowish adherent exudates on the mucosa which were easily taken off. Biopsy and barium enema revealed the same as case 1. The patient was given intravenous fluids with steroids. When the patient was discharged on the tenth hospital day she was asymptomatic and has remained well since then. 　Case 3: A 27-year-old woman presented with abdominal pain and diarrhea after eighteen hours taking oral cephalexin 1,000 mg. Physical examination was normal except slightly abdominal tenderness. Colonoscopy showed multiple irregular erosions covered with white coating in the portion oral from the descending colon. Rectum and sigmoid colon were normal. Biopsy and barium enema revealed the same as case 1. The patient was discharged on the eighth hospital day.

　These 17 cases were all related to oral penicillin derivatives except one case of cephalexin. Mucosal changes of these colitis were located in the right, transverse, and proximal descending colon. The rectum and sigmoid colon appeared normal. While six cases of pseudomembranous colitis related to antibiotics had all abnormal mucosal changes in the rectum and sigmoid colon. Barium enema is valuable within one week from onset of these acute hemorrhagic colitis, but sometimes shows the same picture found in ischemic colitis.