10年後に診断されたビルハルツ住血吸虫症の1例

Abstract

31歳男。5, 6年前肉眼的血尿を認め受診したが異常所見は指摘されなかった。再び血尿が生じたため受診した。血尿は無症候性血尿で頻尿, 排尿痛などは認めなかった。腹部超音波で膀胱前壁に肥厚部位を認めたが表面は平滑であった。CTで膀胱前壁に強く造影される不整な壁肥厚を認め, 膀胱鏡所見では左右尿道口は前壁から項部にかけ不整な粘膜隆起を認め, 血餅が付着しており出血点と思われた。膀胱鏡所見からは良性・悪性腫瘍の鑑別は困難で炎症性病変の可能性もあるためTURバイオプシーを施行した。病理組織所見は全ての標本から粘膜固有層での著しい好酸球浸潤をはじめとする高度慢性炎症細胞浸潤を伴う炎症性肉芽組織形成等を認めた。肉芽組織中には虫卵を多数散在性に認め, 内部にはミラシジウムと思われる構造物が観察され, ビルハイツ住血吸虫症と診断した。

A 31-year-old Japanese man had macroscopic hematuria 5 or 6 years previously. When he was examined at a local hospital, he was pronounced normal. However he still had macroscopic hematuria, so he visited our department. Urine cytodiagnosis was class II. Cystoscopy revealed irregular mucosa at the anterior wall and dome of the bladder. CT and MRI also demonstrated irregular thickness at the anterior wall of the bladder. A diagnosis of bilharziasis was made by histological specimen obtained by TUR-biopsy. The specimen did not show evidence of malignancy. When questioned about overseas travel, he said he had visited Malawi in Africa when he was 20 years old. As international exchange between Japan and other countries is now increasing, we will be examining more patients who have traveled to epidemic areas. In such patients, we should consider the possibility of Schistosomiasis.