胃梅毒に伴う胃潰瘍

Gastric Ulcer Caused by Syphilis Infection, Report of a Case

要旨●胃梅毒の原因となる梅毒感染は増加傾向にあり，特徴的な内視鏡像やX線造影像の理解は，診断や多疾患との鑑別に重要である．典型例と考えられる自験例を提示し，既報の文献的考察を加えて，画像所見について述べる．本症例は20歳代，男性．心窩部痛を主訴に受診，EGDで胃前庭部を中心に不整なびらん，多発潰瘍を認め，膿汁の付着と軽度の壁硬化所見を認めた．胃X線造影検査では，同部位を中心にバリウムの付着ムラと軽度の伸展不良所見を認め，漏斗状狭窄を呈した．画像所見より胃梅毒を疑い，血液学的検査で梅毒抗体が陽性，組織生検により病理学的に梅毒スピロヘータを確認し，診断しえた．アンピシリン内服加療により内視鏡的所見も改善した．

　Recently, cases of syphilis infection have been increasingly reported in Japan because of the diversification of the sexual lifestyle. We present a typical case of gastric syphilis and discuss its endoscopic and radiographic features by reviewing the related literature. A 27-year-old man presented to our clinic with epigastric pain. Endoscopic examination showed multiple erosions and shallow ulcers with irregular margins at the angle and antrum, which were accompanied by pus production and slight wall rigidity that was more pronounced at the area close to the pyloric ring. Upper gastrointestinal series with barium meal showed uneven barium adhesion to the mucosa and slight rigidity of the gastric wall, which formed funnel-shaped stenosis. These typical images along with his blood test being serologically positive for syphilis led us to suspect gastric syphilis. We pathologically confirmed the diagnosis by detecting Treponema pallidum in the biopsied specimen. After treatment with ampicillin for 1 month, the condition of the ulcer significantly improved and was recognized as a small ulcer scar at the angle. The knowledge of these characteristic images of gastric syphilis has important value for the differential diagnosis of gastric syphilis and other morphologically similar diseases.