食道カンジダ症で確診されたAIDSの1例

Severe Candidiasis in the Oral Cavity and the Esophagus that Led to Diagnosis of Human Immunodeficiency Virus (HIV) Infection, Report of a Case

要旨　HIV（human immunodeficiency virus）感染症は，本邦においても徐々に患者数の増加がみられている．1994年6月現在，本邦のHIV感染症者は3,389人，そのうちAIDS（acquired immunodeficiency syndrome）患者は764人である．数年前までは，入院患者の約70％が同性愛者であり，残りが血友病患者や輸血による感染者であったため，特殊なグループの病気と考えられていた．しかし，近年になって異性愛者の患者数が増加し，一般的なSTD（sexually transmitted disease）として考えられるようになってきた．患者自身はHIV抗体の検査を受けず，自分自身が陽性と知らずに生活し，消化器病変と共にAIDSを発症する例もみるようになった．上部消化管内視鏡施行時に発見され，食道カンジダ症の精査中に確診されたAIDS症例の1例を提示する．

　A 30-year-old homosexual male was admitted to our hospital because of odynophagia caused by severe candidiasis in the oral cavity and the esophagus. Further examination revealed HIV infection. Candidiasis showed remarkable improvement after treatment for four days, and it allowed us to detect concomitant ulcers in the middle and lower esophagus which had been covered by thick coatings at the time of the first endoscopy. Studys on bite biopsy specimens from the esophageal ulcers revealed cytomegalovirus (CMV) infection. Odynophagia had disappeared in a few days and endoscopic findings of esophageal ulcers had changed into scars three weeks after application of Foscarnet.

　Recently, the number of cases with sexualy transmitted HIV infection has increased. Some of them were not aware of HIV infection, and came to know about it through evaluation of upper gastrointestinal disorders. In cases with severe candidiasis in the oral cavity or the esophagus, HIV infection should be considered as a possible cause.