粗大結節状隆起を主病変とした回腸末端部結核の1例

Tuberculosis of the Terminal Ileum with Multiple Granular Lesions, Report of a Case

要旨　明らかな潰瘍や潰瘍瘢痕を伴わず，粗大結節状隆起が集籏した極めてまれな回腸末端部結核の1例を報告した．患者は，30歳，女性，主婦．主訴は心窩部痛と発熱．右下腹部に圧痛あり，急性虫垂炎を疑い腹部超音波検査を施行，回腸末端部の肥厚とリンパ節腫大あり，急性回腸末端炎，なかでもエルシニア腸炎が疑われた．注腸造影で回腸末端部に粗大結節状隆起の集籏を認め，内視鏡検査にて粗大結節状隆起の集籏と，隆起の頂点にところどころ白苔を伴うびらんを認めた．生検にて，炎症細胞の高度の浸潤と類上皮細胞の増殖による肉芽腫が多数認められ，腸結核も考えられた．確定診断のためにリンパ節生検が行われ，リンパ節内に乾酪壊死性肉芽腫が認められ腸結核と診断された．抗結核剤の投与により病変は，瘢痕もなく消失した．なお，胸部X線上異常なく，ツ反は9×6mmと疑陽性，糞便中結核菌陰性，組織中の結核菌は，培養を行うも陰性．白血球は11,500と増多，CRP11.9mg/dlと強陽性，赤沈33mm/hrと充進，エルシニア抗体価陰性であった．

　We experienced a case of tuberculosis in the terminal ileum with multiple granular lesions, without any ulcers or scars.

　The patient was a 30-year-old woman. Her chief complaints were epigastralgia and fever. X-ray examination of the chest revealed no abnormalities. Examinations on admission showed leukocytosis, positive CRP and negative tuberculin test.

　Barium enema study of the terminal ileum showed a coarse granular pattern of the mucosa. Endoswpic study of the terminal ileum clarified multiple granular lesions without any ulcers or scars. Biopsy was performed and we could find many granulomas without caseating necrosis.

　Appendectomy and resection of swelling lymph nodes in the terminal ileum were performed. In histological study of the lymph nodes some granulomas with caseating necrosis were found and we diagnosed these lesions as tuberculosis.

　After this patient had been given a trial of antituberculosis therapy for seven months, these lesions were not detected in the terminal ileum.