─最近注目される腸管感染症─サイトメガロウイルス腸炎

Cytomegalovirus Enterocolitis

要旨●サイトメガロウイルス（CMV）感染症は易感染性宿主の日和見感染症として知られている．多くは造血幹細胞移植後，自己免疫性疾患や炎症性腸疾患などの免疫抑制状態や易感染状態を背景としてCMV再活性化がみられるが，慢性腎不全や侵襲的な手術後などにも発症しうる．CMV腸炎は消化器症状，内視鏡検査所見および生検による病理組織学的診断をもって診断される．内視鏡像としては打ち抜き様潰瘍が特徴的とされているが，多彩な潰瘍やびらん性病変を呈することが多い．一方で，発赤・浮腫などの非特異的な炎症所見も多く認められる．治療は抗ウイルス薬であるガンシクロビルが第一選択薬となる．

　CMV（cytomegalovirus）infection is known to be an opportunistic infection that occurs in a compromised host. CMV reactivation often occurs in patients who received hematopoietic stem cell transplantation and who are in an immunosuppressive state, such as autoimmune disease and inflammatory bowel disease. But, it also occurs in patients with chronic renal failure and who have undergone invasive surgeries. CMV enterocolitis is diagnosed by gastrointestinal symptoms, endoscopic findings, and histopathological findings. Although a punched-out ulcer is known to be a characteristic endoscopic finding, various ulcers and erosive lesions are also commonly observed. On the other hand, nonspecific inflammatory findings, such as redness and edema, are often observed. Ganciclovir, an antiviral drug, is the first-line treatment for CMV infection.