偽膜性大腸炎の2小児例

Pseudomembranous Colitis in Children, Report of Two Cases

要旨　基礎疾患のない2歳女児で，多種類の抗生剤が投与された後，下痢・粘血便・腹痛・発熱を主訴に入院，頻回の下痢による直腸脱の粘膜所見より大腸内視鏡検査（CE）を施行し，偽膜性大腸炎（PMC）に典型的な像を得た症例と，第2寛解期のALLの12歳男児で，強力な維持療法後の好中球減少時に感染予防や治療の目的で抗生剤の投与を受けていたが，頻回の水様粘血便と腹痛が出現し便塗抹検査にて多数の好中球と大型のグラム陽性桿菌を認め，CEにて典型的なPMCの像を得た2症例を報告した．2症例ともVCMが著効し再発はみられなかった．CEは迅速かつ確実な診断に有用であった．

　A 2-year-old previously healthy girl was admitted to our hospital with chief complaints of diarrhea, mucous bloody stool (Fig. 2a), abdominal pain and fever. She had been on AMPC, EM, CFIX, and CCL for otitis media and enterocolitis. Because of mucosal changes of the prolapsed rectum (Fig. 2b) due to recurrent diarrhea, colonoscopy was performed eliciting the findings characteristic of PMC (Fig. 3).

　A 12-year-old boy in his second remission of acutelukemia suffered from frequent watery mucous bloody stool and abdominal pain. Different regimens of maintenance therapy had been performed as well as AMPH, PL, KM, GM, and PIPC for prevention of infections. Stool smear examination revealed many neutrophils and large-sized gram-positive rods (Fig. 6). Colonoscopic examination demonstrated the findings typical of PMC (Fig. 7).

　Vancomycin was effective in both cases without recurrence of PMC thereafter. We believe that colonoscopy is useful in diagnosing PMC and should be performed in any cases suspected of having PMC.