大腸に多発潰瘍を認めた腸チフスの1例

Typhoid Fever with Multiple Ulcers in the Colon, Report of a Case

要旨　患者は24歳，女性．発熱，腹痛，下痢，下血を主訴に入院．39℃を上下する弛張熱，比較的徐脈，末梢血の好酸球消失，脾腫を認めた．大腸X線および内視鏡検査にて盲腸から横行結腸ほぼ中央部まで，円形または卵円形の小潰瘍の多発と回腸末端の腫大したPeyer板上に単発の潰瘍を認めた．便培養にてSalmonella typhiが検出され，腸チフスと診断し，福岡市立こども病院感染症センターに転院となった．chloramphenicol 1～2g/日の経口投与にて治療後，当院再入院．多発潰瘍は横行結腸にわずかな変形を残すのみで瘢痕治癒していた．

　A 24-year-old female was admitted to our hospital because of high fever, abdominal pain, diarrhea and melena. On physical examination, the spleen was enlarged. Remittent fever and pulse-temperature dissociations were noted. The differential count of white blood cells showed no eosinophilia. Barium enema and colonoscopic examination revealed multiple round to ovalshaped ulcers from the cecum to mid-transverse colon, and there was a solitary ulcer on the edematous Peyer's patches in the terminal ileum. A stool culture was positive for Salmonella typhi, and with a diagnosis of typhoid fever, she was transferred to Fukuoka Children's Hospital and Medical Center for Infectious Diseases. She was treated with oral chloramphenicol (1-2 gram per day). Follow-up barium enema and colonoscopic examination one and one-half moths after the initial examination showed that the multiple ulcers in the right colon and terminal ileum were healed with minimal deformities in the transverse colon.