腸管出血を呈した川崎病の1例

A case of Kawasaki disease with intussusception.

• Koji Ueharu
• Takeshi Asano
• Ryohei Fukunaga
• Ryosuke Matsui
• Keishi Yoshida
• Chiharu Miyatake-Sudoh
• Masanori Abe
• Atsushi Fujita
• Yasuhiko Ito

抄録

川崎病は病因不明の全身性血管炎であり、様々な消化器疾患を合併することが知られているが、川崎病に伴う腸管出血の症例はこれまでに数例しか報告されていない。川崎病を合併した3歳男児の腸管出血の症例を報告する。本症例は激しい腹痛を訴えて当院に入院した。超音波検査でターゲットサインが認められたため、腸管狭窄と診断し、静水圧療法を行った。入院2日目に高熱（38℃）と不規則な発疹が全身に出現した。入院4日目に高熱が続き、両側非滲出性結膜炎、唇・口腔粘膜紅斑、苺舌、手足背の硬結性浮腫、手のひら・足底のびまん性紅斑が出現し、最終的に川崎病と診断された。治療は免疫グロブリン2g/kg、アスピリン30mg/kg/日、プレドニゾロン2mg/kg/日であった。高悪性度の発熱は，その他の臨床症状と同様に治療開始後すぐに消失した．初回治療後の川崎病症状の再発はなく，入院後10日目に鼠径部周囲剥離が認められた．15日目に退院し、川崎病症状の発症から3ヶ月後に冠動脈拡張などの異常は認められなかった。咳嗽のみの症例と川崎病との年齢分布（3歳以上 vs 3歳未満）は、咳嗽のみの症例に比べて明らかに高齢であった。また、川崎病では腸管出血の部位は主に大腸であり、回腸ではありませんでした。川崎病の特徴的な臨床症状が出現する前に腸管出血が先行した場合には、川崎病の診断が遅れる可能性がある。3歳以上での切腹症例と切腹部位が大腸であった場合の川崎病の診断には注意が必要である。

Kawasaki disease is a systemic vasculitis of unknown etiology and is known to be associated with various digestive disorders, though only a few cases of intussusception associated with Kawasaki disease have been reported. The case of a 3-year-old boy with intussusception followed by Kawasaki disease is reported. The patient was admitted to our hospital due to severe abdominal pain. Because the target sign was seen on ultrasonography, intussusception was diagnosed, and hydrostatic reduction was performed. On the second day after admission, he developed a high-grade fever (38 C) and an irregular rash on the whole body. On the fourth day after admission, his high-grade fever continued, and bilateral non-exudative conjunctivitis, erythema of the lips and oral mucosa, strawberry tongue, indurated edema of the dorsum of his hands and feet, and a diffuse erythema of his palms and soles appeared, and he was finally diagnosed as having Kawasaki disease. He was treated with intravenous immune globulin 2 g/kg, aspirin 30 mg/kg/day, and prednisolone 2 mg/kg/day. The high-grade fever, as well as the other clinical symptoms, resolved immediately after the start of treatment. There was no relapse of Kawasaki disease symptoms after initial treatment, and periungual desquamation was observed on the tenth day after admission. He was discharged on the 15th day and showed no abnormalities, such as coronary dilatation, three months after the onset of the symptoms of Kawasaki disease. Age distribution (≥ 3 years old vs < 3years old) between cases with intussusception and Kawasaki disease was clearly older than that with intussusception only. In addition, location of intussusception with Kawasaki disease was mainly colonic, not ileocolic. If intussusception precedes the appearance of the characteristic clinical symptoms of Kawasaki disease, the diagnosis of Kawasaki disease may be delayed. We must be aware of the diagnosis of Kawasaki disease in cases of intussusception in over three years old and colonic location of intussusception.