経時的に内視鏡で観察したcollagenous sprueの1例

Collagenous Sprue : Serial Observation by Capsule and Double Balloon Endoscopy, Report of a Case

要旨　患者は75歳，女性．主訴は数か月間持続する水様下痢と全身の浮腫で精査目的で当科に入院となった．入院時の小腸内視鏡検査では，小腸の広範囲に絨毛の消失と多発潰瘍を認めた．組織学的にcollagen bandを認め，collagenous sprueと診断した．完全静脈栄養（TPN）で症状は改善したが，内視鏡的には絨毛の再生は認めなかった．プレドニゾロン（PSL）の投与と経口摂取を開始したところ，敗血症や偽膜性腸炎を合併したため，PSLを漸減し，再度TPNとした．偽膜性腸炎改善後の小腸内視鏡検査では，絨毛の再生を認め，collagen bandも消失した．その後，経口摂取を再開し，症状の再燃はない．

　A 75-year-old woman was admitted to our hospital because of watery diarrhea lasting several months and anasarca. On admission, capsule endoscopy and DBE（double-balloon endoscopy）showed a loss of villi associated with multiple ulcers throughout most of the jejunum and ileum. Histological examination of the ileum showed a loss of villi and a subepithelial collagen band of 38～42μm width. Because endoscopic and histological findings indicated collagenous sprue, TPN（total parenteral nutrition）was started. The frequency of diarrhea decreased, and serum levels of C-reactive protein returned to normal, but after 3weeks of TPN, DBE and histopathological examination showed no regeneration of villi but persistence of the collagen band despite some improvement in the ulcerative lesions. Thereafter, oral prednisolone（0.5mg/kg/day）was initiated. Intensive antibiotic therapy for sepsis and Clostridium difficile colitis as well as a reduction in the prednisolone dose was undertaken. Imaging and histological examination after resolution of the infection showed regeneration of villi and disappearance of the collagen band. This is a rare case of collagenous sprue with changes observed in endoscopic findings in the small bowel during treatment.