胃生検にて確診し治癒経過を観察しえた梅毒性胃炎の1例

A Clinical Observation of Syphilitic Gastritis: Biopsy-proven Contagious Treponema Pallidum in the Gastric Mucosa

要旨　35歳女性で上腹部痛，嘔吐にて来院，胃透視で前庭部に漏斗状狭窄がみられ胃癌を疑われたが，内視鏡検査により梅毒性胃炎と確診し，駆梅療法にて治癒しえた1例を報告した．患者は梅毒血清反応強陽性で，胃内視鏡では前庭部に不整形多発びらんがあり，極めて易出血性であった．生検材料の位相差鏡検にて活発に運動するスピロヘータを認め，螢光抗体間接法を用いてT.pallidumを証明したが，鍍銀染色でも胃粘膜組織内にラセン体を確認した．また生検材料のsaline emulsionをラットに接種し，その病原性をも確認しえた．ペニシリン投与により約1か月で臨床症状は改善し胃透視上の壁硬化も消失，3か月後には内視鏡所見も正常に復し治癒を確認した．

　A case of a 35 year-old woman with epigastralgia and vomiting is presented. Although an upper gastrointestinal study initially raised suspicion of gastric cancer (Fig. 2 b), gastrofiberscopic examination disclosed numerous shallow erosions with marked friability (Fig. 3 a, b), and initial gastric biopsy showed intense mononuclear infiltration with no evidence of malignancy (Fig. 5a). Based on these findings, together with a positive result of a serologic test for syphilis, we strongly suspected the presence of syphilitic gastritis. Subsequently, many motile spirochetes were demonstrated in freshly obtained biopsy material washed in saline by phase-contrast microscopy (Fig. 5 b), with strongly positive specific treponemal immunofluorescence (Fig. 6 b). Several spirochetes were also identified with the Warthin-Starry silver stain (Fig. 6 a). To prove the syphilitic nature of this lesion, we inoculated a mouse with saline emulsion of a biopsy specimen. Several weeks later the mouse developed syphilitic orchitis (Fig. 7). The patient was treated with penicillin. Repeated gastroscopy performed after 90 days of therapy revealed complete recovery without scarring (Fig. 4 d).

　This is the first case of syphilitic gastritis reported in Japan where contagious T. pallidum was demonstrated from a gastroscopic biopsy specimen. Endoscopic examination with biopsy and appropriate tissue staining are essential for the diagnosis of syphilitic gastritis, and to the consequent avoidance of surgery.