著者

芦谷 啓吾 山岡 稔 小林 威仁 今枝 博之 中元 秀友 宮川 義隆

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.107, no.2, pp.269-275, 2018-02-10 (Released:2019-02-10)

参考文献数

16

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33歳,男性.1週間持続する発熱と咽頭痛を主訴に地域の病院を受診した.細菌性咽頭炎の診断で抗生物質を投与されたが改善せず,単純CT検査で肝脾腫,脾臓の出血性梗塞を認め,当院に転院した.Epstein-Barr virus (EBV)関連抗体であるvirus capsid antigen(VCA)-IgMが陽性,EBV DNA定量が4.7×103 copies/106 cellsと上昇していることから,伝染性単核球症に合併した脾梗塞と診断した.伝染性単核球症の発症中に,ループスアンチコアグラントが一過性に陽性となり,脾梗塞発症への関与が疑われた.

著者

松本 悠 都築 義和 芦谷 啓吾 大庫 秀樹 市村 隆也 佐々木 淳 中元 秀友 今枝 博之

出版者

一般社団法人 日本消化器内視鏡学会 関東支部

雑誌

Progress of Digestive Endoscopy (ISSN:13489844)

巻号頁・発行日

vol.96, no.1, pp.151-153, 2020-06-26 (Released:2020-07-07)

参考文献数

5

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Olmesartan has recently been reported as a cause of drug-induced enteropathy characterized by chronic diarrhoea and duodenal mucosal atrophy demonstrating sprue-like enteropathy. 82-year-old, male presented to our hospital because of chronic severe watery diarrhea without abdominal pain or fever. Blood examination showed mild anemia (Hb 11.2 mg/dl). Abdominal contrast-enhanced computed tomography showed mucosal edema in the large intestine. Esophagogastroduodenoscopy showed no villous atrophy in the duodenum with the possibility of pyloric gastrectomy, however, colonoscopy showed villous flattering in the terminal ileum and edematous changes in sigmoid colon. Histopathologic examination in biopsy samples from the terminal ileum and sigmoid colon showed interstitial lymphocytic infiltration. He was treated with olmesartan for hypertension at least two years before the onset of symptoms. In addition, watery diarrhea improved soon after discontinuation of olmesartan. Therefore, he was diagnosed as olmesartan-induced enteropathy. Its pathogenesis remains unclear; however, olmesartan-induced enteropathy must be included in the differential diagnosis for patients with chronic diarrhea after the intake of olmesartan.

著者

大崎 篤史 芦谷 啓吾 大庫 秀樹 山岡 稔 市村 隆也 李 治平 永田 耕治 茅野 秀一 宮川 義隆 山本 啓二 中元 秀友 今枝 博之

出版者

一般社団法人 日本消化器内視鏡学会 関東支部

雑誌

Progress of Digestive Endoscopy (ISSN:13489844)

巻号頁・発行日

vol.87, no.1, pp.160-161, 2015-12-12 (Released:2016-01-06)

参考文献数

10

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A 60-oyear-oold male visited a clinic because of gastric discomfort. This symptom was temporarily improved by a proton pump inhibitor, but it was worsened by discontinuation of the drug. He was referred to our hospital. Esophagogastroduodenoscopy showed an elevated lesion with multiple whitish small granular protrusions in the duodenal second portion, occupying two thirds of the circumference. The lesion was diagnosed to be a follicular lymphoma by histopathological examination including immunostaining of the biopsy specimens. He was admitted to our hospital. Abdominal CT scan showed no lymph node metastasis. Capsule endoscopy of the small intestine showed lymphoid follicles in the distal ileum in addition to the duodenal lesion. Bone marrow aspiration showed no invasion of lymphoma cells. This case was diagnosed as stage I according to the Lugano international conference classification. He underwent monotherapy using rituximab four times. However, the lesion did not respond. Therefore, radiotherapy was added which induced regression of the duodenal lesion. Follow-oup capsule endoscopy did not show any lesion in the distal ileum. As long-term outcome after treatment for duodenal follicular lymphoma is not known, strict observation is considered to be necessary.