著者

酒井 伸也 近藤 春樹 高相 豊太郎

出版者

千葉大学

雑誌

千葉医学雑誌 (ISSN:03035476)

巻号頁・発行日

vol.68, no.3, pp.141-145, 1992-06-01

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38歳の男性が1985年肺門,頸部,鼠径部リンパ節腫脹で入院。リンパ節,肝生検でサルコイドーシスと診断した。以後無治療で経過観察していたが,1990年発熱,貧血で再入院した。入院時検査所見ではRBC 142×10^4/μl, Hb 5.5g/dl, Retics. 17.2%, Plt 25.3×10^4/μl, WBC 5300/μl, Bilirubin 2.07mg/dl, LDH 1305IU/l, Haptoglobin 10mg/dl以下,Coombs試験が陽性であり,骨髄では赤芽球系が過形成だった。以上の所見より自己免疫性溶血性貧血(AIHA)と診断し,60mg/dayのプレドニゾロン(以下プレ)治療を開始,貧血は漸次改善したが,満月様顔貌,ざ瘡,股関節の無菌性壊死などのプレの副作用が出現した。溶血の再発と上述の副作用を防ぐ目的でプレを減量し,400mg/dayのダナゾール(以下ダナ)を加え治療した。プレ減量にても溶血の進行が認められなかったので,両薬剤量を徐々に減量,最終的に1991年5月,プレ中止,ダナ50mg/dayでRBC, Hb, Ret.共に正常域にあり,プレの副作用も消失した。サルコイドーシスに合併したAIHAは稀であるが,基礎にある免疫学的異常が両疾患を引き起こすと考えられ,今後その機序の解明が待たれる。プレを長期使用せざるおえないようなAIHAに,その副作用を防ぐ意味でもダナ療法は有効と考えられるが,ダナのAIHAに対する作用機序も未だ十分解明されておらず,将来本症例のような貴重な症例の蓄積によって解決されるのが望まれる。

著者

横川 宗雄 吉村 裕之 金田 丞亮 鈴木 太郎 高相 豊太郎 吉田 貞利 門馬 良吉 酒井 章 寺畑 嘉朔 田崎 喜昭

出版者

千葉大学

雑誌

千葉医学会雑誌 (ISSN:00093459)

巻号頁・発行日

vol.38, no.6, pp.516-522, 1963-03-28

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The first case ; Male, 26 years old, employee. Shimizu city, Shizuoka prefecture. Chief complaints : stomachache, nausea, anorexia and slight fever since a few years ago. The general condition was rather good. The results of examinations of both urine and blood were almost normal. No helminth ova were found, but occult blood was positive in the fecal examination. Gastrectomy was carried out under the diagnosis of gastric ulcer. A cherry-sized and localized tumor was found at Pylorus of the stomach. Eosinophilic abscess surrounded with eosinophilic granulation in submucosa of the stomach, and two or three transverse sections of the parasite in the center of this abscess were observed histophathologically. The worm sections were examined morphologically. From the morphological characters of the cuticular spines, intestine and the other organs of this parasite, it was identified as the larva of 4-5 mm in length of Gnathostoma spinigerum Owen, 1836. The second case ; Male, 31 years old, employee. Kanazawa city, Ishikawa prefecture. The occult blood of gastric juice and feees were strong positive, but the results of examinetions of urine and pepipheral blood were normal and no helminth ova were found in feces. Gastrectomy was carried out under the diagnosis of gastric ulcer, like as the first case. A grapesized tumor was found in the ventral site of the greater curvature of the stomach. Histopathological finding was eosinophilic granulation with two transverse sections of the worm. Morphological observations of the cuticule, oesophagus, lateral lines, intestine on the transverse sections of the worm were carried out, and the worm was identified as the immature worm of 30〜35 mm in length of Ascaris lumbricoides.