10)免疫不全（無γグロブリン血症を含む）―多発大腸潰瘍を認めた分類不能型免疫不全症の1例

Immunodeficiency (including agammaglobu-linemia) ; a Case of Common Variable Immunodeficiency (CVID) with Multiple Colonic Ulcers

　免疫不全症においては，さまざまの頻度での消化管病変の合併が指摘されているが，その病態は明らかでない．今回，分類不能型免疫不全症の自験例での検討をふまえ，免疫不全症における消化管病変の特徴につき考察した．症例は23歳，女性．下痢，便潜血陽性の原因精査中に上行結腸から直腸に多発する潰瘍性病変を指摘された．炎症性腸疾患に準じた治療で緩解したが，潰瘍からの生検標本にて多数のアポトーシス小体が指摘された．GVHDなどのアポトーシス小体が増加する病態の存在は否定的で，特徴的所見と考えられた．原発性免疫不全患者の消化管病変は，既存のカテゴリーにあてはまらない病態として位置づけられる可能性がある．

　The pathogenesis of gastrointestinal tract lesions in patients with primary immunodeficiency remains unknown. We present a case of CVID, a 23-year-old woman, suffering from multiple colonic ulcers, which were small and well-demarcated. Colonic biopsy specimens showed many apoptotic bodies, although she had no evidence of graft-versus-host disease or any other cause of apoptotic body increase. Therefore, these findings were thought to be a specific phenomenon at such a case as hers. It may be that immunodeficiency is associated with its own patterns of gastrointestinal inflammation that do not readily fit into established diagnostic categories.