アフタ性病変を伴ったキャンピロバクター腸炎の1例

Campylobacter Colitis with Aphthoid Lesions, Report of a Case

要旨　患者は左下腹部痛，水様性下痢便，下血を主訴に来院した21歳の男性．大腸内視鏡検査で直腸から脾彎曲部にかけて，広範囲に発赤したアフタ様のびらんがあり，回盲弁上に浅い潰瘍を認めた．注腸X線検査では，直腸から脾彎曲部にかけて小バリウム斑と淡い小円形陰影の多発があり，アフタ様びらんの多発した所見だった．全結腸にかけて網目像を認め，粘膜の粗槌化や偽ポリポーシスの所見はなく，潰瘍性大腸炎は否定的で，感染性腸炎，特にキャンピロバクター腸炎が疑われた，便培養の結果，Campylobacter jejuniiが陽性で，オフロキサシン600mg/日の服用で症状は軽快した．感染性腸炎の診断でも，大腸内視鏡検査，注腸X線検査を行うことにより，便培養の結果が判明する前に十分に疑診を得られる症例もあると考えられる．

　A 21-year-old man was admitted to our hospital because of bloody diarrhea and abdominal pain. Colonoscopic examination disclosed erythematous and aphthous erosions from the rectum to splenic flexure and shallow ulcerative lesions on the Bauhin's valve. Histologic examination of the biopsy specimens of erythematous erolions in the sigmoid colon showed crypt abscesses, a decrease in the number of goblet cells, and infiltration of acute inflammatory cells. Barium enema showed small niches in the rectum, sigmoid and descending colon, and the edematous Bauhin's valve. A stool culture on the day of admission was positive for Cumpylobarter jejunii. He was diagnosed with Campylobacter colitis based on the colonoscopic examination and barium enema. He was rapidly improved with of loxacin. We believe that colonoscopic examination and barium enema are useful for diagnosis of infectious colitis.