生検でTreponema Pallidumが証明された第2期胃梅毒の1例

Syphilitic Gastritis Diagnosed by Demonstrating Treponema Pallidum in the Gastric Mucosa, Report of a Case

要旨　39歳，女性が激しい心窩部痛，嘔吐を主訴として来院した．胃X線と胃内視鏡の所見では壁の伸展は良好であるが，胃体部より前庭部にかけて大小不同の粗大顆粒状変化と角部にやや深い不整形の潰瘍を認めた．生検所見で固有粘膜内にリンパ球と形質細胞浸潤が強く認められ，血清梅毒反応が陽性を示したことより，Warthin-Starry染色と螢光抗体法による検索を行った結果，Treponema Pallidumを胃粘膜組織中に証明した．第2期胃梅毒と確診し駆梅療法を行い，第2クール終了後血清梅毒反応は低下し，自覚症状も改善した．内視鏡所見では駆梅療法開始後約40日で角部の潰瘍は瘢痕化し，粘膜も全体に正常に復した．

　A 39-year-old woman was admitted to the hospital because of severe epigastralgia, nausea and vomiting. The upper gastrointestinal series showed multiple shallow ulcers and granular appearance of the corpus and antrum of the stomach. Rigidity of the antral portion was not noted (Fig. 1). On the endoscopic examination, ulcers with irregular shape were found at corporal and antral portions. These ulcers were covered with coagula and surrounded with uneven mucosa (Figs. 2, 3). Presumptive diagnosis was malignancy of the stomach. Biopsy specimens from the margin of the ulcer, however, showed intense infiltration of lymphocytes and plasma cells, but no evidence of malignancy (Fig. 4). These histological findings of the biopsy specimen, together with positive serologic test for syphilis, were in favor of the diagnosis of syphilitic gastritis. Warthin-Starry silver impregnantation (Fig. 5) and immunofluorescent staining (Fig. 6) of the biopsy specimen were positive for Treponema pallidum in the gastric mucosa and the diagnosis of syphilitic gastritis was established. Treatment with penicillin for 40 days resulted in marked improvement of the subjective symptoms and the endoscopic findings (Fig. 7).