偽膜性大腸炎の1治験例

Pseudomembranous Colitis: Report of a successfully treated case

　偽膜性小腸結腸炎は小腸および大膜粘膜の急性表層性壊死と偽膜形成を主徴とし，重症下痢，脱水，時にはショックを伴い死にいたる炎症性疾患であり，その病態についてはまだ十分には明らかにされていない．本症は1867年Billroth¹⁵⁾によって最初に記載されて以来，今日まで海外文献には多数の報告がみられるが本邦では極めて少なく特にその治験例についての詳細な報告はまだみられない．

　われわれは最近抗生物質投与によると思われる偽膜性大腸炎の1治験例を経験したので報告し若干の考察を加えたい．

　A housewife aged 81 years was admitted to our hospital because of severe watery diarrhea and fever. Nine days before the onset of these symptoms, she had received prophylactic intramuscular injection of Lincomycin (LCM) 600 mg for 3 days because of right radius fracture. Otherwise there was no predisposing cause or evidence of infection. On sigmoidoscopy a large number of small,yellowish-white, raised nodules were seen lining the rectal mucosa, which appeared somewhat inflamed but was not granular nor ulcerative. These nodules proved histologically to be pseudomembrane consisting of fibrin, neutrophils and sloughed epithels.

　A barium enema was grossly abnormal showing ‘thumb-printing’ in the entire colon but the small intestine was radiographically normal. Colonoscopic examination was performed up to the cecum and the same change as was seen in the rectum was observed through the entire colon, especially in the hepatic flexure and the sigmoid colon. Stool culture showed no evidence of pathogens, ova or fungi.

　A diagnosis of LCM-associated pseudomembranous colitis was made. The vigorous hyperalimentation and correction of electrolyte imbalance through the CVP catheter were effective in the treatment of the patient.

　The possible causes of LCM-associated pseudomembranous colitis are discussed.