戦争イソスポーラ長期感染の1例

Chronic Isospora belli Infection Report of a Case

要旨　患者は71歳，男性．主訴は17年来の下痢と，ときに認める高熱．初診時，羸痩著明で低アルブミン血症と高IgE血症を認めた．入院後，糞便および十二指腸液からIsospora belliのoocystを検出，更に十二指腸生検で粘膜上皮細胞内に各発育段階のIsospora belliを認め，イソスポーラ症と診断した．消化管検査では食道，胃，大腸に著変はなかったが，小腸にKerckring皺襞の消失と粗ぞうな凹凸不整粘膜をびまん性に認めた．特に十二指腸第2部の所見は高度で，組織学的には著明な慢性炎症性細胞と好酸球の浸潤ならびに浮腫と線維化を認めた．免疫不全を示唆する基礎疾患は認められなかった．diaminopyrimidine・sulfonamide合剤が著効を示したが，投与中止2か月後に再発したため少量持続投与に切り替え経過は良好である．

　A 71-year-old man was admitted to our hospital, complaining of diarrhea and occasional pyrexia over the last 17 years. Laboratory data showed remarkably high serum IgE level. The diagnosis of isosporiasis was made by detection of sporulated oocysts in the stool and duodenal juice, and was confirmed by the parasites of different stages in the duodenal biopsy specimens. Radiographic and endoscopic examinations revealed that coarse and rough mucosa with innumerable fine granules and absence of Kerckring's folds in the duodenum and small intestine, especially in the second portion of the duodenum. Histological findings of the biopsy specimen from the duodenal mucosa showed atrophy of villi, edema, fibrosis, and dense infiltration of inflammatory cells such as mononuclear cells and eosinophils. No abnormal findings were observed in the esophagus, stomach, and colon. Various examinations did not show any other underlying diseases including immunodeficiency. The patient was treated successfully with trimethoprim-sulfamethoxazole (TMP-SMX), but recurred two months after termination of the therapy.