寛解期の潰瘍性大腸炎に生じ，感染性肺塞栓症を合併した脳膿瘍の1例

Ulcerative Colitis in Remission with Cerebral Abscess and Septic Pulmonary Emboli:A Case Report

Ⅰ．はじめに

　潰瘍性大腸炎が易感染性であることは広く知られており，稀な腸管外合併症として深部静脈血栓症や肺塞栓症が報告されている．また潰瘍性大腸炎の脳膿瘍合併は報告例が非常に少ない．今回われわれは寛解期の潰瘍性大腸炎に脳膿瘍および感染性肺塞栓症を合併した稀な1例を経験した．その発症機序に関する検討と文献的考察を加えて報告する．

　A 69-year-old man with a 4-year history of ulcerative colitis（UC）presented at our hospital with high fever, dysarthria, and right hemiparesis. Computed tomography（CT）of the head revealed a low-density area in the left temporal lobe. Chest CT exposed multiple pulmonary nodules in his right lung. Gadolinium-enhanced magnetic resonance imaging（MRI）indicated a 3-cm tumor with ring enhancement located in the left temporal lobe. The patient was diagnosed with a brain abscess and septic pulmonary emboli（SPE）;antibiotic therapy was initiated. Shrinkage of the brain abscess was not observed in a follow-up MRI;thus, he underwent aspiration and drainage of the abscess 11 days after his hospitalization. Intravenous antibiotic therapy was continued for 6 weeks after the operation. Follow-up chest CT performed 48 days after his hospitalization revealed disappearance of the SPE. Follow-up head MRI conducted 63 days after his hospitalization indicated that the cyst had almost disappeared. Occurrence of a brain abscess in patients with UC has been very rarely reported in Japan. To the best of our knowledge, this is the first report of a case of a brain abscess in conjunction with UC and SPE. It is believed that patients with UC have compromised immunity and exhibit activation of the blood coagulation system. Our report suggests that medical practitioners should consider the possibility of a brain abscess and SPE for patients with UC.