クラミジア直腸炎の1例

Chlamydia Trachomatis Proctitis, Report of a Case

要旨　患者は26歳の女性で，3か月間続く粘血便を主訴に当科受診した．大腸内視鏡検査で肛門縁より約5cmの範囲全周性に，光沢を有するほぼ均一な半球状小隆起の集簇，いわゆる“イクラ状粘膜”を認めた．生検病理組織ではリンパ濾胞を形成する非特異的炎症像を認めた．血清Chlamydia trachomatis（C.t.）抗体陽性，直腸粘膜擦過診，子宮頸管・腟部擦過診でC.t.抗原陽性であり，クラミジア直腸炎と診断した．本症例は治療に難渋したが，minocycline hydrochlorideの長期経口投与により，内視鏡所見の改善とC.t.抗原の陰性化を認めた．非特異的直腸炎の鑑別として，性行為感染症が蔓延している現況においてクラミジア直腸炎も念頭に置くべきと考えられた．

　A 26-year-old female visited our hospital because of three months of continuous hematochezia. A colonoscopic and barium enema examination revealed multiple glossy granular lesions at the Rb region of the rectum, which resembled the so-called “salmon roe appearance”. Histological findings of the biopsy specimens showed non-specific inflammation characterized by lymphoid follicles with marked mononuclear cells and infiltration of plasma cells. The results of the rectal and cervical smear of Chlamydia Trachomatis antigen were positive. The serological results of IgG and IgA of the Chlamydia antibody were also positive. Because of this, we diagnosed the patient as having Chlamydia Trachomatis proctitis. After oral treatment with minocycline (200 mg/day, 5 months), colonoscopic findings improved remarkably and all of the serological results changed to negative. Nowadays, since there is an increase of sexually transmitted disease, we suggest that Chlamydia trachomatis proctitis should be considered as one of the differential diagnoses of proctitis.