特徴的な内視鏡像を呈し，臨床的にWhipple病と診断し得た1例

Whipple's Disease with Typical Endoscopic Features, Report of a Clinically Diagnosed Case

要旨●患者は76歳の男性．主訴は下痢で，止痢剤にても改善を認めず当科に入院した．体重減少，著明な低蛋白血症を呈し，腹部造影CTで全小腸に浮腫性壁肥厚と散発性の腸間膜リンパ節腫大を認めた．上下部消化管内視鏡検査で，上十二指腸角から肛門側と終末回腸に，白色絨毛がびまん性に認められた．小腸カプセル内視鏡検査により，病変は全小腸に及ぶことを確認した．病変部の鉗子生検の病理組織学的所見は，粘膜固有層にPAS染色陽性で泡沫状のマクロファージがびまん性に多数集簇した像が特徴的であり，Whipple病と診断した．抗菌薬投与後1週間ほどで，下痢は消失した．約5か月の経過で，異常検査値は基準内に改善し，上部消化管内視鏡検査で，白色絨毛は消失した．

　A 76-year-old man was admitted to our hospital presenting with pharmacoresistent diarrhea, loss, and hypoproteinemia. CT（computed tomography）of the abdomen revealed thickening of the small bowel wall and enlarged mesenteric lymph nodes. Diffuse white shaggy villi of the duodenum and terminal ileum were observed on upper and lower endoscopy. In addition, capsule endoscopy revealed white villi in the entire intestine. On histological examination of the biopsy specimens, the lamina propria of the intestinal mucosa was densely infiltrated by rich foamy macrophages that were periodic acid-Schiff（PAS）-positive. Based on these pathological findings, the patient was diagnosed with Whipple's disease. After one week of antibiotic therapy, the patient recovered from diarrhea. At 5-months follow-up, laboratory data had improved, returning to the normal range and diffuse white shaggy villi were unclear on endoscopic examination.