小腸病変の診断にカプセル内視鏡検査が有用であった好酸球性多発血管炎性肉芽腫症（Churg-Strauss症候群）の1例

Eosinophilic Granulomatosis with Polyangiitis（Churg-Strauss Syndrome）with Multiple Small Intestinal Ulcers Efficiently Diagnosed by Video Capsule Enteroscopy and Double-balloon Enteroscopy, Report of a Case

要旨●患者は63歳，女性．10年前に好酸球性多発血管炎性肉芽腫症〔Churg-Strauss症候群（CSS）〕に対し加療歴がある．腹痛，下痢を主訴に来院した．上下部内視鏡検査，腹部造影CT検査では腹痛の原因を指摘できなかったが，CSSの小腸病変を疑い小腸カプセル内視鏡検査を施行したところ，上部空腸を中心に全周性に境界明瞭な辺縁発赤を伴う潰瘍とびらんの多発を認め，腹痛の原因と思われた．プレドニゾロンの用量を50mg/dayに変更することで腹痛は速やかに軽快し，小腸カプセル内視鏡検査がCSSの消化管病変の診断に大変有用であった．

　A 63-year-old woman was referred to our hospital for general malaise, chronic abdominal pain, and watery diarrhea. A blood test revealed eosinophilia, positive serum MPO-ANCA, and an elevated serum IgE level, suggesting CSS（Churg-Strauss syndrome）. Esophagogastroduodenoscopy, total colonoscopy, and abdominal computed tomography did not reveal the cause of the abdominal pain. Video capsule endoscopy showed multiple small ulcers scattered in the small intestine. Biopsy specimens of jejunal mucosa using double-balloon enteroscopy revealed submucosal vasculitis with the infiltration of chronic inflammatory cells, which was confirmative of CSS. In our case, video capsule enteroscopy was very useful and was less invasive for efficiently diagnosing small intestinal lesions of CSS. Moreover, double-balloon enteroscopy revealed small notch-like erosions, which may be one of the early-phase small intestinal lesions of CSS.