梅毒性胃腸炎―その疾患概念の実証

Syphilitic Gastroenteritis; Certification of the Disease Entity

要旨　胃梅毒の4例を経験し，全例に駆梅療法前に大腸内視鏡検査を施行したところ，1例に直腸に大型びらん様病変を，他の1例には盲腸にリンパ濾胞の過形成様の病変を認めた．酵素抗体ABC法による梅毒特殊染色で，各々の直腸・盲腸病変部からの生検標本に梅毒スピロヘータが証明された．この成績から胃梅毒，直腸梅毒は各々独立した疾患ではなく，いわゆる梅毒性胃腸炎の一部分症としてとらえるべきものと考えた．

　We experienced four patients with gastric syphilis in the secondary stage with characteristic irregular-shaped ulcerative lesions in the pyloric antrum (Fig. 1, 2, 5, 6). Before starting anti-syphilitic treatment, all patients underwent colonofiberscopy, which revealed a large verruciform lesion in the rectum in a patient (Fig. 3a) and lymphoid hyperplasia-like lesions in the caecum in another patient (Fig. 7).

　We diagnosed these colonic mucosal lesions as syphilitic, because Treponema pallidum was confirmed by immunohistochemical staining (ABC method) in both specimens obtained from the rectal (Fig. 4b) and caecal lesions (Fig. 96) and these lesions disappeared with antisyphilitic therapy. Based on these results, we considered that gastric syphilis and rectal syphilis are not separate disease entities and that each lesion represents a part of what is termed as syphilitic gastroenteritis.