胃梅毒の1例

Gastric Syphilis, Report of a Case

要旨　胃梅毒は比較的珍しい疾患であるが，近年，本邦では増加傾向にあると思われる．しかし，問題点としては悪性疾患との鑑別が困難であるということが挙げられる．患者は32歳，男性．嘔気，上腹部痛を主訴として，1985年10月中旬当院を受診した．X線検査，内視鏡所見より，スキルス型胃癌が疑われ，生検時の捺印細胞診にてもclass4であった．しかし，病理組織学的には悪性所見は認められず，また，梅毒血清反応が強陽性と判明したため，胃梅毒の可能性も考え駆梅療法を施行することとした．治療開始後1か月後には症状，内視鏡所見の改善を認めたため，われわれは本症例を胃梅毒と診断した．

　Gastric syphilis is relatively rare, but recently, cases in Japan seem to be on the increase (Table 1). The differential diagnosis of gastic syphilis from malignancy, however, is very difficult.

　A 32 year-old man was reffered to our hospital with complaints of nausea and dull pain in the epigastrium.

　X-ray examination showed rigidity and poor distensibility of the gastric walls from the gastric angle to the pyloric antrum, and nodular mucosal changes of the antrum. Compression method was used (Fig. 1, 2).

　Endoscopic finding showed rough unevenness of the mucosa with tissue defects. Tissue in the antrum was tinged with a dirty red color (Fig. 3). Cytological examination revealed class 4 on gastric biopsy. By these findings this case was suspected, at first, of being gastric scirrhous.

　But based on the fact that no malignancy was found histologically (Fig. 7) and the fact that there was a positive result in the serological test for syphilis, we strongly suspected this to be a case of gastric syphilis. We decided to treat the patient for syphilis and followed up closely with endoscopy and biopsy examination.

　Dull pain in the epigastrium was relieved and x-ray and endoscopy revealed improvement after one month's treatment with PEPC (Fig. 4～6). Relying on these facts we diagnosed this case as gastric syphilis.