発症早期より治癒・再発までの全経過を観察しえた偽膜性大腸炎の1例

Pseudomembranous Colitis, Report of a Case

　われわれは高齢者に発症したamoxicillin（以下AMPC）によると思われる偽膜性大腸炎の1例を経験した．自験例は発症早期のX線および内視鏡検査にて典型的な像を呈し，vancomycin，metronidazoleの投与により治癒し，その後再発を来すという興味ある経過をたどった．この全経過をX線・内視鏡検査にて観察しえたので，文献的考察を混じえ報告する．

　An 88-year-old woman had a pseudomembranous colitis which was considered to be due to amoxicillin. Roentgenographically and endoscopically, we observed the entire course of the disease-early, healed, and recurrent stages. After milk intake, this patient had diarrhea for which the diagnosis of infectious colitis was made. Two days after she had been treated with amoxicillin 1g/day, she was admitted to our hospital because of marked mucowatery diarrhea, abdominal pain and fever. Barium enema examination showed characteristic findings of pseudomembranous colitis such as brush-like changes on the margin, narrowing, thumbprinting, rounded and irregular mucosal filling defects. Endoscopic examination showed multiple white yellowish rounded and irregular shaped polypoid lesions.Intervening mucosa was edematous and mucosal vascular network was disturbed. On the basis of both microscopic findings of the biopsy specimen and endoscopic findings, the diagnosis of pseudomembranous colitis was made. Stool examination for bacteria did not reveal Clostridium difficile. However, other examinations led to the diagnosis of pseudomembranous colitis and administration of vancomycin was started. Diarrhea disappeared on the eighth day of the treatment with vancomycin. Endoscopic examination showed gradual decrease in size and number, and eventual disappearance of pseudomembrane on the 11th day of treatment. Intervening mucosa showed less degree of edema and vascular network became visible. Thereafter metronidazole was administered orally. On the seventh day after the administration of the drug was stopped, there was a recurrent diarrhea. Endoscopic examination on the 41th day of admission showed that recurrent pseudomembrane formation was most marked in the rectum with less involvement of the proximal areas. After recurrence, administration of metronidazole led to cure. She has had no recurrent disease thereafter. Throughout the course of early, healed, and recurrent stages, there had been no ulcer formations in the colonic mucosa.