症例報告 メトロニダゾールに対する副反応のためにチニダゾールで治療し得た後天性免疫不全症候群に併発したアメーバ性大腸炎の1例  [in Japanese] Case reports: A case of amoebic colitis associated with AIDS successfully treated with tinidazole following an allergic reaction to metronidazole  [in Japanese]

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Author(s)

    • 渡辺 珠美 Tamami WATANABE
    • 自治医科大学附属さいたま医療センター総合診療科 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University
    • 菅原 斉 Hitoshi SUGAWARA
    • 自治医科大学附属さいたま医療センター総合診療科 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University
    • 松林 洋志 [他] Hiroshi MATSUBAYASHI
    • 自治医科大学附属さいたま医療センター総合診療科 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University
    • 石井 彰 Akira ISHII
    • 自治医科大学附属さいたま医療センター総合診療科 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University
    • 青木 厚 Atsushi AOKI
    • 自治医科大学附属さいたま医療センター総合診療科 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University
    • 牛丸 信也 Shinya USHIMARU
    • 自治医科大学附属さいたま医療センター消化器科 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University
    • 野首 光弘 Mitsuhiro NOKUBI
    • 自治医科大学附属さいたま医療センター病理部 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University
    • 西田 淳二 Junji NISHIDA
    • 自治医科大学附属さいたま医療センター血液科 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University
    • 吉田 行雄 Yukio YOSHIDA
    • 自治医科大学附属さいたま医療センター消化器科 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University
    • 川上 正舒 Masanobu KAWAKAMI
    • 自治医科大学附属さいたま医療センター総合診療科 Division of General Medicine, Clinical Department of Internal Medicine Saitama Medical Center, Jichi Medical University

Abstract

メトロニダゾールに対する副反応のためにチニダゾールで治療した後天性免疫不全症候群に併発したアメーバ性大腸炎を経験した。症例は42歳,男性。入院3ヶ月前から下痢が持続し他院入院。下部内視鏡検査でアメーバ性大腸炎と診断され,メトロニダゾールの内服が開始された。投与3日目に四肢と前胸部に皮疹が出現したため内服を中止した。その後,食欲低下と急激な体重減少,会話時の息切れ,動悸が出現し当院を受診。ヒト免疫不全ウイルス-RNA 量が2.0×106コピー/ml,末梢血CD4陽性リンパ球数が63 /μlであったことから後天性免疫不全症候群に併発したニューモシスチス肺炎による低酸素血症の診断で入院となった。なお,同性愛については再三否定。sulfamethoxazole-trimetoprim合剤とプレドニゾロンによる治療中,第11病日より39℃台の発熱と頻回の水様性下痢が見られた。第15病日に下部内視鏡検査を施行したところ,大腸粘膜全体の糜爛形成と生検組織内にアメーバ虫体を認め,アメーバ性大腸炎の再発と診断。第17病日よりメトロニダゾールの投与開始し解熱傾向となった。しかし,第22病日に再度39℃台の発熱が出現したためメトロニダゾールを中止し,チニダゾールの内服に変更した。その後は,発熱なく下痢の回数も減少し便潜血も陰性化した。外来でHighly Active Anti-Retroviral Therapyを開始する方針となり,第43病日に退院した。メトロニダゾール,チニダゾールともにアメーバ性大腸炎の治療薬としては,保険適応外の使用であり,早期の適応症追加が望まれる。

The case of a 42-year-old man with amoebic colitis associated with acquired immunodeficiency syndrome (AIDS) treated with tinidazole following an allergic reaction to metronidazole is presented. The patient had a 3-month history of persistent diarrhea. At another hospital, amoebic colitis was diagnosed by colonoscopy, and metronidazole was prescribed. A rash appeared on his limbs and chest 3 days after metronidazole was initiated, so it was discontinued. When the patient subsequently developed appetite loss, weight loss, exertional dyspnea, and palpitations, he was referred to our hospital. We found that he had Pneumocystis jiroveci pneumonitis associated with AIDS. The patient denied sexual intercourse with men. His HIV-RNA viral load was 2.0×106 copies/ml, and his CD4 cell count was 63 /μl. His symptoms improved with sulfamethoxazole-trimethoprim and prednisolone. On the 11th day after admission, his temperature rose to 38°C, and he had frequent, watery diarrhea. On the 15th day, colonoscopy showed erosive lesions along the entire colonic mucosa and amoebiasis in the specimen biopsy. On the 17th day, the patient began to take metronidazole. On the 22th day, his temperature rose to 38°C again, but no skin rash appeared. Because of the increased temperature, the medication was switched from metronidazole to tinidazole. As a result, his temperature returned to normal the next day, the frequent diarrhea decreased, and the results of the fecal occult blood tests became negative. The patient was discharged on the 43rd day, with a plan to receive highly active anti-retroviral therapy on an outpatient basis. Because both metronidazole and tinidazole are used to successfully treat amoebic colitis in Japan, we hope that the healthcare payment system will begin to cover the use of these drugs as soon as possible.

Journal

  • Jichi Medical University journal

    Jichi Medical University journal 33, 147-153, 2010

    Jichi Medical University

Codes

  • NII Article ID (NAID)
    110008507492
  • NII NACSIS-CAT ID (NCID)
    AA12194963
  • Text Lang
    JPN
  • Journal Type
    大学紀要
  • ISSN
    1881252X
  • NDL Article ID
    11122937
  • NDL Source Classification
    ZS7(科学技術--医学)
  • NDL Call No.
    Z19-965
  • Data Source
    NDL  NII-ELS 
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