抗酸菌感染を伴った肉芽腫性胃炎の1例

Granulomatous Gastritis Caused by Mycobacterium Infection, Report of a Case

要旨●患者は40歳代，女性．心窩部痛，悪心を主訴に近医を受診，多発性胃潰瘍の精査加療目的で当科に紹介となった．上部消化管内視鏡検査では，胃体部小彎を中心に不整形ないし地図状の浅い潰瘍が多発し胃体中部大彎には瘢痕も伴っていた．胃粘膜生検で多核巨細胞を伴う類上皮細胞肉芽腫を認め，胃粘膜生検培養で抗酸菌陽性であった．抗原特異的インターフェロンγ遊離検査陽性，ツベルクリン反応強陽性に加え，CTで右前肺底部のすりガラス影と腹腔内石灰化を認めたため，抗結核療法を開始した．副作用により4か月後に内服中止となったが，治療後の内視鏡検査で胃体部小彎の潰瘍は瘢痕化し，胃粘膜生検培養も陰性となった．以上より，抗酸菌感染による肉芽腫性胃炎と考えられた．

　A 49-year-old woman was admitted to a referring hospital with symptoms of epigastric pain and nausea. Upper gastrointestinal endoscopy revealed multiple gastric ulcers and scars on the lesser curvature of the gastric body. Biopsies obtained from the ulcers and atrophic mucosa showed epithelioid cell granulomas with multinucleated giant cells. A skin test for tuberculosis with a purified protein derivative of tuberculin and QFT（QuantiFERON）was positive. CT（Computed tomography）demonstrated abdominal calcification and ground-glass opacity in the anterior basal segment of the right lung. Because cultures of gastric mucosa detected acid-fast bacilli twice, the patient was started on antituberculosis therapy. After 4 months, the therapy had to be stopped because of adverse effects. Repeated upper gastrointestinal endoscopy after the therapy showed scarred ulcers and negative results for mycobacterium culture. The diagnosis of granulomatous gastritis caused by mycobacterium infection was made.