健常高齢者に発症し，巨大な深掘れ打ち抜き潰瘍および長い偽腔形成を伴う多彩な画像所見を呈したサイトメガロウイルス食道病変の1例

Cytomegalovirus（CMV）-associated Esophageal Lesions with a Huge Punched-out Esophageal Ulcer and Long False Lumen in a Healthy Elderly, Report of a Case

要旨●患者は基礎疾患のない70歳代，女性．食道違和感を主訴に来院した．EGDおよび食道X線造影検査で頸部食道〜胸部上部食道（Ut）に約6cmの巨大な深掘れ打ち抜き潰瘍，Utに粘膜橋，Ut〜扁平円柱上皮接合部近傍まで長い偽腔を形成し，下部食道では真腔に黄白色粘膜の結節状隆起を認めた．潰瘍底から生検された炎症性肉芽組織内に，免疫組織化学的にサイトメガロウイルス（CMV）陽性の細胞が確認され，CMV食道病変と診断した．打ち抜き潰瘍と黄白色粘膜の結節状隆起はCMV食道病変に典型的所見であったが，長い偽腔形成は非典型的な所見であった．偽腔の存在により固形物の摂取が困難であり，偽腔を内視鏡的に切開し解放した．本例は健常高齢者に発症し，食道全域に多彩な画像所見を呈したまれな症例と考えられた．

　Our case concerns a 70-year-old woman with no underlying disease. She complained of esophageal discomfort and visited a hospital. A huge punched-out ulcer extending from the cervical esophagus to the upper thoracic esophagus and the mucosal bridge in the upper thoracic esophagus was observed. Besides, a false lumen extending from the middle thoracic esophagus to the near squamocolumnar junction was formed. Additionally, nodosity with yellowish-white mucosa was observed in the true lumen of the lower esophagus under upper gastrointestinal endoscopy and esophageal fluoroscopy.

　Some positive cells were revealed in a biopsy specimen obtained from the ulcer floor via immunohistochemistry using anti-CMV（cytomegalovirus）antibodies ; thus, she was diagnosed with CMV-associated esophageal lesions. Punched-out ulcer and nodosity with yellowish-white mucosa are typical findings in CMV-associated esophageal lesions ; however, the long false lumen was an atypical finding. It was challenging to take a solid because of the false lumen. Hence, we endoscopically incised and released. We considered this case to be rare because the subject was a healthy elderly person but presented various imaging findings in the entire esophagus.