著者

堀野 敬 木村 正美 西村 卓祐 松下 弘雄 井上 光弘 鶴田 豊 川田 康誠 廣松 賢治

出版者

一般社団法人日本消化器外科学会

雑誌

日本消化器外科学会雑誌 (ISSN:03869768)

巻号頁・発行日

vol.40, no.2, pp.186-191, 2007-02-01

被引用文献数

4

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症例は53歳の男性で,右季肋部痛を主訴に近医を受診した.血液検査で肝機能障害を認めたため精査加療目的で当科紹介となった.腹部CTおよびMRIで膵頭部に約3cmの腫瘤と腹腔動脈根部リンパ節の腫大を認めた.腫瘍マーカー(CEA, CA19-9)は陰性であったが,magnetic resonance cholangiopancreatographyで膵内の総胆管に狭窄を認め膵頭部癌が強く疑われたため幽門輪温存膵十二指腸切除術を施行した.経過は良好で術後第38日に退院となった.切除標本の病理組織学的検査所見では悪性所見はなく,好酸球性肉芽腫であったことから寄生虫症が疑われ,アニサキス特異的抗体を利用した血清免疫学的検査が陽性であったため膵アニサキス症が強く疑われた.消化管外アニサキス症はまれであり剖検例などで偶然発見される場合が多く,特に膵アニサキス症はほとんど報告されていない.自験例に若干の文献的考察を加え報告する.

著者

高嶋 伸幹 矢澤 省吾 石原 明 杉本 精一郎 塩見 一剛 廣松 賢治 中里 雅光

出版者

日本神経学会

雑誌

臨床神経学 (ISSN:0009918X)

巻号頁・発行日

vol.48, no.1, pp.30-35, 2008 (Released:2008-01-25)

参考文献数

8

被引用文献数

2 3

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We report a 49-year-old man who was a human T-cell leukemia virus type 1 (HTLV-1) carrier, born in Okinawa prefecture where both strongyloidiasis and HTLV-1 are endemic. He presented with fever, headache and urinary retention. On the basis of CSF examination and MRI findings, his condition was diagnosed as myelitis. He received methylprednisolone pulse therapy. He was transferred to our hospital due to severe paralytic ileus. Strongyloides stercoralis (S. stercoralis) was found in the duodenal stained tissue of a biopsy specimen. Ivermectin applied both orally and through enema were ineffective because of severe ileus and intestinal bleeding. Nine mg (200μg/kg) of ivermectin solution was administered subcutaneously every other day for five days (total amount 45mg). The S. stercoralis burden in the stool decreased and paralytic ileus gradually resolved. Three weeks after the resolution of S. stercoralis infection, purulent meningitis developed and acute obstructive hydrocephalus appeared. The hydrocephalus improved by ventricular drainage. Approximately three months after drainage, he died of incidental aspiratory pneumonia. Autopsy showed neither eggs nor larvae of S. stercoralis in the organs. In this case, the fourth reported case in the world, subcutaneous ivermectin injection was dramatically effective. We should consider a diagnosis of strongyloidiasis for any patient from Okinawa prefecture who was an HTLV-1 carrier presenting with unknown origin ileus after treatment of steroid therapy.