全結腸にびまん性に潰瘍の多発をみたサルモネラ腸炎の1例

Salmonella Typhimurium Colitis with Diffuse Ulcers throughout the Colon, Report of a Case

要旨　患者は23歳，女性．39℃台の発熱，1日十数行の下痢，左上腹部痛を主訴として来院．注腸造影にてS状結腸口側～上行結腸のほぼ中央部までhaustraの消失と，びまん性に潰瘍の多発を認めた．検査成績では短期問に進行する貧血，低蛋白血症，電解質異常と高度の炎症所見を認めた．保存的療法に反応せず，腹部単純写真にて横行結腸～下行結腸に一致すると思われる鉛管状のガス像を認めた．その径は短期間に増大し，toxic dilatationを合併した潰瘍性大腸炎（UC）との鑑別に苦慮した．しかし，発症は急激であり，X線・内視鏡上，直腸の所見は軽微であることより，サルモネラ腸炎を含む感染性腸炎を疑い抗生物質を投与した．投与直前の便培養によりSalmonella typhimuriumが検出され，サルモネラ腸炎と確診した．本例は，大腸潰瘍の治癒に3か月以上を要しており，本邦報告中最も重症の症例と考えられた．

　A 23-year-old woman was admitted to our hospital with complaints of fever, diarrhea and left upper abdominal pain. Barium enema examination revealed disappearance of haustration and collar button-like ulceradons in the proximal part of the sigmoid colon to the mid-ascending colon. Laboratory data showed severe anemia, hypoproteinemia, disorders of electrolyte, and signs of inflammation. Distended lead pipe-like air-filled loops of bowel, suggestive of toxic dilatation, were noted on a plain film of the abdomen. These findings were indistinguishable from ulcerative colitis with toxic dilatation. She was successfully treated with antibiotics because infectious colitis was suspected because of the abrupt onset of symptoms and characteristic findings by barium enema and endoscopy. Stool culture done immediately before the abministration of antibiotics was positive for Salmonella typhimurium. It was then that the final diagnosis of salmonella colitis was made. This case was considered to be the most severe of the reported cases of this disease in Japanese medical literature.