クリオグロブリン血症性血管炎の1例

Cryoglobulinemic Vasculitis：A Case Study

要旨●消化管に虚血による病変を生じるまれな疾患として，クリオグロブリン血症性血管炎を提示する．患者は40歳代，男性．HCV陽性患者で直接作用型抗ウイルス薬による治療中に腹痛を生じ，消化管検査を行った．十二指腸に不整形の潰瘍を複数認め，大腸にはびらんが散見された．小腸には潰瘍や潰瘍瘢痕が観察された．クリオグロブリン弱陽性であり，クリオフィルトレーションと直接作用型抗ウイルス薬による治療を行った．経過中，横行結腸の瘢痕部から血管炎の所見が得られ，クリオグロブリン血症性血管炎と診断した．報告が少ないため消化管病変の特徴は明らかではないが，治療に結び付けるため鑑別診断として考えることは重要である．

　We present a rare case of cryoglobulinemic vasculitis causing ischemic lesions in the gastrointestinal tract. A 40s man who had tested positive for HCV（hepatitis C virus）developed abdominal pain during treatment with direct-acting antiviral drugs. Esophagogastroduodenoscopy revealed several irregular ulcers in the duodenum. Colonoscopy revealed erosion on the transverse colon. Ulcers and ulcer scars were observed in the small intestine. The patient's laboratory data revealed that he had tested positive for cryoglobulins ; he was treated with cryofiltration and continued antiviral therapy. During the treatment, evidence of vasculitis was obtained from the ulcer scar of the transverse colon, resulting in the diagnosis of cryoglobulinemic vasculitis. Because of the limited number of reports, the characteristics of gastrointestinal involvement remain unclear. It is essential to consider cryoglobulinemic vasculitis as a differential diagnosis because it may be treatable.