小腸に主病変を呈した好酸球性多発血管炎性肉芽腫症の1例

Eosinophilic Granulomatosis with Polyangiitis Presenting Multiple Ulcerative Lesions in the Small Intestine, Report of a Case

要旨●患者は60歳代，男性．20XX-1年夏頃に咳嗽が出現し，気管支喘息と診断された．20XX年6月頃に下腹部痛が出現し，7月初旬に上下肢のしびれと下痢を認めたため，当院入院となった．上部消化管内視鏡検査では，胃全摘後の吻合部空腸側に周囲の発赤が目立つびらんを認め，生検では粘膜下層に著明な好酸球浸潤を認めた．カプセル小腸内視鏡検査，ダブルバルーン小腸内視鏡検査では，全小腸にわたり大小さまざまな発赤粘膜やびらん・潰瘍性病変を認めた．一方，大腸には直腸の軽度発赤粘膜を認めるのみであった．本症例は気管支喘息，好酸球増加，多発性単神経炎を合併していたことから，好酸球性多発血管炎性肉芽腫症と診断し，プレドニゾロン50mg/dayの内服およびシクロホスファミド大量静注療法で加療したところ，小腸病変は速やかに改善した．

　A 60-year-old man with a 1-year history of bronchial asthma was referred to our institution owing to lower abdominal pain, diarrhea, and numbness of the upper and lower extremities. While esophagogastroduodenoscopy revealed multiple reddish mucosa and erosions in the jejunum, a biopsy of the jejunal mucosa detected dense eosinophilic infiltration in the submucosa. In addition, capsule endoscopy and double-balloon enteroscopy findings determined multiple erosions and ulcers of variable sizes along with adjoining reddish mucosa throughout the small intestine. Subsequently, the patient was diagnosed with eosinophilic granulomatosis with polyangiitis on the basis of the combination of bronchial asthma, eosinophilia, and multiple mononeuropathy. Accordingly, we initiated therapy with the administration of oral prednisolone（50mg/day）and intravenous cyclophosphamide（500mg/m²）, which resulted in significant improvement of the small intestinal lesions.