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No.18(2007) >

Please use this identifier to cite or link to this item: http://hdl.handle.net/10087/8880

Title: Whipple病の超微形態
Other Titles: An Ultrastructural Study of a Case of Whipple's Disease
Authors: 瀬野尾, 章
瓜生, 恭平
儘田, 明央
岡田, 久美子
羽山, 忠良
Senoo, Akira
Uryu, Kyohei
Mamada, Akio
Okada, Kumiko
Hayama, Tadayoshi
Keywords: Whilpple病
十二指腸生検
超微形態
Whipple'sdisease
Smallintestinebiopsy
Ultrastructur
Issue Date: 6-Dec-2007
Citation: 桐生短期大学紀要 18, 9-16, 2007
Abstract: 本国では稀な疾患であるWhipple病の1例について,経時的な小腸生検からの組織を電子顕微鏡的に検討したので,その結果に考察を加え報告する.症例は日本人の男性で,主訴は食欲不振,体重減少と発熱で,平成12年1月からの8か月で12kgの体重減少があり,同年10月,精査目的に八尾徳川会病院を紹介受診し,入院後,高カロリー輸液による栄養管理と抗生物質投与により体重増加が認められ,同年12月に退院となり,以後外来で経過観察された.平成14年5月に小腸生検を行い,光学顕微鏡検索では,小腸粘膜固有層と粘膜下組織に微細顆粒状で灰白色の胞体をもつ多数のfoamy macrophagesが観察され, PAS染色陽性であった.電顕所見では,直径0.2ミクロンで長さが2-3ミクロンの桿菌が細胞外に多数認められた.また, macrophages内では菌体と判明できるものから,電子密度の低い指紋様構造を呈するものまで,様々な消化段階のものが認められた. Whipple病と診断され,抗生物質治療が行われ,約2年後の生検では光顕的には多数のmacrophagesが観察されたが,電顕的には菌体は観察されなかった.さらに5か月後の生検では,光顕的にfoamy macrophagesがわずかに観察され,電顕的にはその細胞質内に指紋様ないし細線維状構造を示す不定形顆粒が認められた. The biopsied specimens taken from the small intestine of a patient with Whipple's disease which is rare in Japan were examined by electron microscopy. The result of the examination along with discussions are presented in this paper. This case involves a Japanese male whose chief complaints were appetite loss, weight loss and fever. The patient experienced a weight loss of 12 kg for a period of 8 months from January, 2000, and was admitted to the Yao General Hospital in October of the same year. He was discharged from the hospital in December of the same year after his weight increase was confirmed following the administration of antibiotics and nutritional management by intravenous hyperalimentation. In the first small intestine biopsy in May of 2002, a lot of foamy macrophages with fine granular grayish cytoplasm was observed in a lamina propria of a mucosa. The macrophages were deeply stained by periodic-acid Shiff reaction. By electron microscopic examination, numerous bacilli that measure 0.2 micron in diameter and 2 to 3 micron in length were observed in a extracellular space of the lamina propria, and a variety of digestive stages of bacilli was recognized in the cytoplasm of the macrophages. The patient was diagnosed as Whipple's disease, and was treated by antibiotics. About 2 years later, the bacillus was not observed through electron microscopy, although a lot of foamy macrophages were observed in the biopsied specimen by light microscopy. In the biopsied specimens taken 5 months after, the foamy macrophages were slightly observed. The cytoplasm of macrophage contained irregular-shaped granules which showed fingerprint and/or fibrillar structure, but bacillus was not observed.
URI: http://hdl.handle.net/10087/8880
ISSN: 13424076
Appears in Collections:No.18(2007)

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