消化吸収障害の認められたジューリング疱疹状皮膚炎

DERMATITIS HERPETIFORMIS DUHRING ASSOCIATED WITH DIGESTION AND ABSORPTION DISTURBANCE

はじめに

　ここ数年間，ジューリング疱疹状皮膚炎における小腸の異常が論じられている。本疾患において高頻度に，空腸粘膜に異常所見の認められることは，1966年Marksら^1），により初めて記載されたところである。その後，英国，オランダにおいて，その検索がすすめられ，本疾患の多くの症例に，空腸粘膜の構造変化，機能異常が認めれている。このことは，消化管とジューリング疱疹状皮膚炎の病態発生との関連において，興味のあるところである。しかしながら本邦では，ジューリング疱疹状皮膚炎について，これらの検索がなされた例はみられない。

　この度，我々もジューリング疱疹状皮膚炎の1例を経験し，空腸の生検と，2，3の消化吸収検査を行ない若干の考察を加えたので，ここに報告する。

A 66-year-old female started many erythemato-vesicular lesions with severe itch on the fore-arms in July 1968, which enlarged and extended to the trunk and lower extremities gradually.She was admitted to the Niigata University Hospital. The lesions occupied almost the entire body surface except head, hands and feet. They were polymorphic, severely itchy and composed of bullae, erosions or crusts on the urticaria-like erythematous macules.

Histologic specimen showed subepidermal bullae contained with many eosinophils and neut-rophils.

Though the lesions were severe at her admission, they became milder after steroid and non-gluten diet treatment. Digestion and absorption tests were performed at this milder stage.Slight disturbance on lipid absorption was proved by excreted amount of lipids in faeces and by the absorption test with ¹³¹I-triolein. Although there was no abnormality in the biopsied speci-men from the ileum mucous membrane, activities of hydrolytic enzymes of disaccharides-maltase, sucrase, lactase-were low. These results showed absorption disturbances of intestine as Marks et al reported.