鼻ライシュマニアの1例について—アメリカ・ライシュマニア症

AMERICAN LEISHMANIASIS, A CASE REPORT

　Ⅰ．緒言

　化学療法のめざましい発展がみられる今日，結核・梅毒等の慢性炎症による外鼻の変化がみられる事は少ない。反面，外鼻の変化は悪性腫瘍及び所謂進行性エソ性鼻炎によるものが問題にされる。今回私は外観進行性エソ性鼻炎を思わせ，発病状況・臨床所見・病理組織検査から現在非常に稀れなライシュマニヤ症と診断し，治療軽快し得た症例を経験したのでここに報告する。尚本症例は今日迄経過観察中である。

A 50 year-old man whose chief complaints were redness and swelling of the external nose and sore throat was admitted to the Japan Red Cross Central Hospital in April,1962.

The personal history revealed that the, patient had lived in the Brazilian interior for the period of 5 years since 1934. Soon after his. return to this country he had noted the appe-arance of the present symptoms. During this. 20 year interval the patient received various treatments, elsewhere, without a definite diagnosis nor avail.

Leishmaniasis was suspected but, various repeated tests failed to reveal specific organ-ism. However, a diagnosis of American Leishmaniasis (L. Brasiliens) was made tentatively because of the following clinical findings :

1. The history of 5 years residence in the interior Brazil with a long standing cli- nical symptoms thereafter.

2. The presence of hemorrhagic granula- tions and ulcerations in the nasophary- nx.

3. Destruction of nasal cartilage evide- ncing septal perforation.

4. The presence of chronic granulornatous inflammation (though no tumor cell was reported in the microscopic examinati- on.)

The patient was placed on the drug therapy using trivalent antimony compound and chlo-roquine for the period of 30 days. A consi-derable improvement has been seen in the patient's condition but, he is still being close-ly observed.