Cytomegalovirus感染を伴う食道・胃潰瘍の1生検例

Esophagogastric Ulcer with Cytomegalovirus Infection, Report of a Case

要旨　患者は31歳，男性．急性骨髄性白血病に罹患．制癌剤，ステロイドにより寛解状態になり，維持療法中に咽頭痛および心窩部不快感があり，内視鏡検査にて食道および胃に潰瘍を認めた．潰瘍部よりの生検組織にて食道では肉芽組織中の血管内皮細胞に，胃では腺細胞と血管内皮細胞に巨大封入体細胞が認められた．また，パラフィン切片での螢光抗体法により核内封入体ならびに細胞質内小体に一致してcytomegalovirus抗原を確認した．

　A 31 year-old man was admitted to the Mizusawa Municipal Hospital because of acute myeloblastic leukemia, and was treated by chemotherapy and prednisolone. In remission, the patient was serially examined by gastroendoscopy for sore throat and epigastralgia. The ulcerative lesions of the esophagus and stomach were disclosed by endoscopical examination. Histological examination revealed cytomegalic inclusions in the capillary endothelial cells and the glandular cells in the biopsy specimens obtained from the ulcers and their surrounding tissue of the esophagus and stomach. No cytomegalic inclusions were observed in squamous cells of the mucous membrane of the esophagus. An immunofluorescent study of the formalin-fixed, paraffin-embedded biopsy specimens disclosed cytomegalovirus antigen in intranuclear inclusion and cytoplasm of cytomegalic cells.

　Ulcerative lesions have been thought to be caused by ischemia due to swelling of endothelial cells of the capillary induced by cytomegalovirus infection.