急性症状を呈した胃アニサキス症の3例―特にその免疫血清学的診断法の意義について

A Study on the Diagnosis of Three Cases of Anisakiasis by Means of Immunoserological Techniques

　わが国におけるアニサキス症については，石倉ら¹⁾，岩野ら²⁾の調査によると1972年主でに496例が報告され，その後，徐ら³⁾によると1978年7月現在770例以上が報告されている．一方，並木ら⁴⁾は生きたアニサキス様幼虫を内視鏡下に発見し，これら早期に発見される例においては好酸球性肉芽腫は認められず，また生の魚を食べて数時間後に“食あたり”様の急性胃症状を呈してくることから，このような例に対し急性胃アニサキス症と称することを提案した．

　最近著者らも，いずれも生のサバを食べて急性胃症状を呈した胃アニサキズ症と思われる症例を経験し，その血清学的診断について検討したので報告する．

　Three patients with gastric anisakiasis diagnosed by immunological techniques are reported.

　In the first patient, an anisakis-like larva was found first by an x-ray examination of the stomach following the patient's complaints of nausea, vomiting and epigastralgia a few hours after eating pickled mackerel. Anisakiasis was confirmed endoscopically. No gastric lesion was found two weeks later either fluoroscopically or endoscopically.

　The second patient complained of severe epigastralgia immediately after eating pickled mackerel. The first x-ray examination revealed giant folds in the antrum of the stomach with resemblance to a gastric cancer of scirrhus-type, but three larvae were found at the following endoscopic examination.

　The third patient complained of severe epigastralgia one hour after eating raw mackerel as in the second, but a large tumor was revealed at the fornix of the stomach by the first x-ray examination, which disappeared two weeks later leaving two ulcers at the same position.

　In these three cases, the morphological diagnosis was possible only in the first case, lacking not only the morphology of larvae but also any histological evidence in the second and the third cases. The third case was misdiagnosed as gastric cancer at first. Eosinophilic infiltration in the biopsy specimen and the disappearing tumor made us suspect anisakiasis. In all cases, the final diagnosis was established by immunological techniques such as Ouchterlony's method and immunoelectrophoresis. Their importance in the diagnosis of anisakiasis is particularly emphasized.