直腸膣瘻と直腸膀胱瘻を合併したサイトメガロウイルス直腸炎の１例

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  • A CASE OF CYTOMEGALOVIRUS PROCTITIS ASSOCIATED WITH BOTH RECTOVAGINAL AND RECTOVESICAL FISTULAE

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An 86-year-old woman was admitted for anorexia and diarrhea (sometimes bloody diarrhea). Colonoscopy revealed proctitis associated with both a huge fistula, through which a scope was easily inserted into the vagina, and a huge deep one adjacent to the urinary bladder, 2 cm and 8 cm from the anus respectively. Histological examination of biopsy specimens from the fistula revealed intranuclear inclusion bodies, and positive immunostaining for cytomegalovirus (CMV) antigen. Serum levels of anti-CMV antibody IgG and IgM were elevated but no serum antigen of CMV was detected. She was diagnosed as having CMV proctitis with fistulae. Serum assay of anti-HIV antibody was negative and serum level of CD4/8 ratio was normal. Three weeks after admission she complained of fecaluria. Colonoscopy revealed 2 orifices, through which a lumen of the urinary bladder was observed, in the base of the huge fistula 8 cm from the anus. Transurethral cystography showed that contrast media in the bladder flowed out through a f istulous tract (2.5 cm in diameter and 4 cm in length) into the rectum and then from the rectum into the vagina. She was treated with ganciclovir for 2 weeks and received transverse colostomy. Two months later cystography, showed that no contrast media in the bladder leaked. Three months later colonoscopy showed that the rectovaginal fistula decreased in size and the rectovesical one diminished. To our knowledge three cases of a rectovaginal fistula due to CMV infection and no case of a rectovesical fistula due to CMV infection have been reported from 1983. This was a rare immunocompetent case of CMV proctitis with both rectovaginal and rectovesical fistulae.

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