画像所見にて診断し経過観察をしえたWhipple病の1例

Whipple's Disease Diagnosed Based on Imaging, Report of a Case

要旨●患者は70歳代，男性．主訴は，黒色便，下痢．小腸X線造影検査では，ほぼ全小腸に粘膜粗糙，細顆粒から小顆粒状の隆起をびまん性に認めた．内視鏡検査では十二指腸から下部小腸にかけてびまん性に白色絨毛を認め，以上の画像所見からWhipple病が疑われた．十二指腸からの生検で粘膜固有層内に多数の泡沫状マクロファージ，脂肪滴を認め，電子顕微鏡観察でTropheryma whippleiを同定し確定診断した．CTRX，ST合剤の加療にて症状は改善した．さらに治療1か月後の内視鏡検査では，十二指腸の病変は著明に改善し，びまん性の白色絨毛は消退していた．今回，本邦においてまれなWhipple病の各種画像所見を経時的に確認しえたので報告する．

　A man in his 70s presented with chief complaints of black stools and diarrhea. On small bowel X-ray, mucosal roughness of the entire small bowel and diffuse, fine-to-small granular protrusions were evident. On endoscopic examination, diffuse white villi were seen from the duodenum to the lower small bowel. Whipple's disease was suspected from these imaging findings. In a tissue biopsy from the duodenum, many foamy macrophages and lipid droplets were seen in the lamina propria. A definitive diagnosis of Whipple's disease was made by identifying Tropheryma whipplei on electron microscopy. Symptoms improved with treatment using a combination of CTRX and ST. Endoscopic examination 1 month later showed marked improvement of the lesions in the duodenum and disappearance of the diffuse white villi. In this case, findings on several imaging modalities were confirmed over time in a case of Whipple's disease, which is rare in Japan.