粘膜下腫瘍様の内視鏡像を呈した粟粒結核症の腸病変の1例

Colonic Tuberculosis with Submucosal Tumor-like Lesion Accompanied by Miliary Tuberculosis, Report of a Case

要旨●患者は67歳，女性．前医で成人Still病と診断され，加療が行われたが発熱などの臨床症状が改善しないため当院へ転院となる．転院後，免疫抑制剤やステロイド薬の投与などの加療中に突然下血を認めた．大腸内視鏡検査では盲腸から直腸にかけて多発する粟粒大の白色粘膜下腫瘍様隆起を認めた．生検組織から炎症細胞浸潤を伴う壊死組織および抗酸菌が確認された．その後の全身精査で喀痰，肝臓，骨髄，胃液の培養検査で結核菌が検出されたため，粟粒結核症と診断した．腸結核で粘膜下腫瘍様の所見がみられることは大変まれである．また，本例は腸病変から粟粒結核症の診断に至った症例であり，教訓的であるため報告する．

　A 67-year-old woman was referred to our hospital for further investigation and treatment for adult Still's disease. She presented with high fever and persistent general fatigue despite treatment. At the time of admission, hematochezia occurred suddenly during steroid and immunosuppressive therapy. Colonoscopic examination revealed multiple white submucosal lesions at the colon and rectum. Biopsy specimens from these lesions contain inflammatory and necrotic tissues and acid-fast bacterium as seen by Ziehl-Neelsen stain. Further investigation revealed that she developed miliary tuberculosis. Based on these findings, we diagnosed that the colonic lesion was accompanied by miliary tuberculosis.