ウェルシュ菌を疑われる起炎菌により,出血性壊死性腸炎にて死亡した神経性食思不振症患者の剖検例  [in Japanese] Autopsy Report for an Anorexia Nervosa Patient Who Died of Hemorrhagic Necrotic Colitis due to Suspected Clostridium perfringens Infection  [in Japanese]

患者は23歳,女性.低体重にてX-2年9月に当院を初めて受診した.神経性食思不振症と診断され,即日入院となった.行動療法を行うことによって体重が増加し,同年12月に退院した.その後外来でも体重は増加しつつあったが,X-1年6月を最後に通院が途絶えた.X年2月1日,夜間より腹痛を生じ他院を受診し,点滴を受けたが症状は改善せず,翌朝当院に受診した.来院時,極度の低体重を認めるとともにショック状態であり,人工呼吸の施行と,輸液,昇圧剤,ステロイド,重炭酸塩などの投与による救命治療がなされた.全身状態は一時改善したが,麻痺性イレウスと消化管出血を生じ,来院より17時間後に死亡,その後剖検が施行された.剖検結果および臨床症状より,出血性壊死性腸炎,腸管嚢腫様気腫症,門脈内ガス血症と診断した.この原因としてウェルシュ菌感染が強く疑われた.ウェルシュ菌は自然界に広く存在するとともに,ヒトや動物の腸管常在菌であり,発病や死を生じるようなことはきわめてまれである.しかし神経性食思不振症患者のように低栄養で免疫力の低下がある患者にとっては,重篤な転帰をたどることもあると考えられた.

The patient was a 23-year-old woman. In September "X-2" year, she visited our hospital due to excessive weight loss. Anorexia nervosa was diagnosed and she was hospitalized the same day. Condition improved with behavior therapy at the hospital and she was discharged in December. However, she discontinued follow-ups at the hospital until June "X-1" year. On February 1, "X" year, the patient experienced abdominal pain during the night, so she visited another hospital and received drip infusion. Condition worsened and she was brought to our hospital the next morning. On arrival, she was severely emaciated and in shock, so immediate rescue with artificial respiration and drip infusion of saline, corticosteroid, vasopressor and bicarbonate was initiated. Condition improved temporarily, but paralytic ileus and gastrointestinal bleeding developed and she died 17h after arrival. Based on autopsy findings and clinical symptoms, hemorrhagic necrotic colitis, pneumatosis cystoids intestinalis and hepatic portal vein gas were diagnosed. Clostridium perfringens was considered as the causative agent. This bacterium is widely distributed in the environment and frequently occurs in the intestinal tract of humans and many domestic and feral animals. Complications and death only occur very rarely. However, in malnourished patients with poor immune status as seen with anorexia nervosa, C. perfringens may cause severe disease.