Treponema pallidumが証明された梅毒性直腸炎の1例

Syphilitic Proctitis Demonstrating Treponema Pallidum from Affected Regions, Report of a Case

　Homosexualにより発症し，螢光抗体法により病変部からTreponema pallidumが証明された梅毒性直腸炎の1例を報告し，若干の文献的考察を加える．

　A 51 year-old man was admitted on February 10, 1982 with the chief complaint of bloody stool and anal pain on defecation. His personal history showed that he had been a homosexual from twenties and that he had his last sexual connection in December 1981. Physical examination on admission demonstrated flat raises, 7～8 mm in diameter, with clear borderlines, on the scrotum and the anus. Digital examination revealed a soft tumor in the anterior wall of the rectum. Laboratory data included occult blood, ESR 80 mm/h and a strongly positive reaction to the serologic test for syphilis.

　Sigmoidoscopic findings showed soft, elevated lesions on the anterior wall of the lower rectum associated with an irregular, shallow ulcer in the central region, and longitudinal broad erosive changes with thin white coat, edema and hemorrhage extending from the posterior to the left lateral wall of the upper rectum.

　Histological examination of the biopsy specimens revealed numerous inflammatory cell infiltration chiefly in plasma cell and evidence of vasculitis, but no evidence of malignancy. Immunofluorescent antibody technique conducted in the biopsy specimen demonstrated specific fluorescence for Treponema pallidum.

　On the basis of these findings, a diagnosis of syphilitic proctitis was made. The patient was treated with methicillin sodium, and in the second week of treatment, his rectal lesions improved markedly.

　This is the first case of syphilitic proctitis reported in Japan where Treponema pallidum was demonstrated from affected regions.