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Stomach and Intestine(Tokyo) Volume 53, Issue 4 （April 2018）

胃と腸 53巻4号（2018年4月発行）

Japanese English

今月の主題腸管感染症─最新の話題を含めて

主題症例

Whipple病 Whipple's disease 蔵原晃一 ¹ , 川崎啓祐 ^1,2 , 長末智寛 ^1,3 , 八板弘樹 ¹ , 大城由美 ⁴ , 小林広幸 ^1,5 Koichi Kurahara ¹ , Keisuke Kawasaki ^1,2 , Tomohiro Nagasue ^1,3 , Hiroki Yaita ¹ , Yumi Oshiro ⁴ , Hiroyuki Kobayashi ^1,5 ¹松山赤十字病院胃腸センター ²岩手医科大学医学部内科学講座消化器内科消化管分野 ³九州大学大学院医学研究院病態機能内科学 ⁴松山赤十字病院病理部 ⁵福岡山王病院消化器内科 ¹Division of Gastroenterology, Matsuyama Red-cross Hospital, Matsuyama, Japan ²Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan ³Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ⁴Department of Pathology, Matsuyama Red-cross Hospital, Matsuyama, Japan ⁵Institute of Gastroenterology, Fukuoka Sanno Hospital, Fukuoka, Japan キーワード： Whipple病 , 白色絨毛 , 十二指腸 , カプセル小腸内視鏡 , バルーン小腸内視鏡 Keyword: Whipple病 , 白色絨毛 , 十二指腸 , カプセル小腸内視鏡 , バルーン小腸内視鏡 pp.489-495

発行日 2018年4月25日 Published Date 2018/4/25

DOI https://doi.org/10.11477/mf.1403201337

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要旨●［症例1］患者は54歳，男性．半年間持続する水様下痢，約10kgの体重減少を主訴に当科入院．十二指腸第2部から終末回腸にわたる全小腸に，白色絨毛を伴う浮腫状粘膜をびまん性に認め，生検病理所見で粘膜固有層内に多数のPAS染色陽性泡沫状マクロファージを認めた．Whipple病が強く疑われ，診断的治療目的にCTRXとST合剤を投与し，著明な改善傾向を認めた．［症例2］患者は50歳，男性．3か月間持続する水様下痢と約25kgの体重減少を主訴に当科入院．十二指腸を含む全小腸にびまん性の白色絨毛と粘膜浮腫を認め，十二指腸と小腸から採取した生検病理所見，電子顕微鏡所見とPCR法により確定診断した．CTRXとST合剤の投与により著明な改善傾向を認めた．

　Case 1：A 54-year-old male was admitted to the hospital with reported continuous watery diarrhea for 6 months as well as weight loss of approximately 10kg. Diffuse edematous mucosa accompanied by white villi was observed along the full length of the small intestine from the second section of the duodenum to the terminal ileum. Biopsy revealed multiple PAS（periodic-acid Schiff）-positive foamy macrophages in the lamina propria, and Whipple's disease was strongly suspected. Following the administration of a CTRX and ST compound agent for diagnosis and treatment, a marked improvement was observed.

　Case 2：A 50-year-old male was admitted to the hospital with reported continuous diarrhea for 3 months as well as weight loss of approximately 25kg. Diffuse edematous mucosa accompanied by white villi was observed in the small intestine, including the duodenum. The diagnosis was determined by biopsy, electron microscopy, and the PCR（polymerase chain reaction）technique. A marked improvement was observed following the administration of a CTRX and ST compound agent.