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抗結核療法に対する逆説的反応としての腸管穿孔。症例報告
Intestinal Perforation as a Paradoxical Reaction to Antitubercular Therapy: A Case Report.
PMID: 32674552 DOI: 10.3393/ac.2020.03.16.1.
抄録
結核（TB）治療に対する逆説的反応は、初期の臨床症状の改善に続いて、既存の結核病変の臨床的または放射線学的な悪化、または新たな病変の発生を特徴とする。消化管結核における腸管穿孔は、抗結核療法の逆説的反応として起こることがある。55 歳の男性が下腹部痛と体重減少を訴えて外来を受診した。腸結核と診断され，抗結核療法を開始した。抗結核治療3ヶ月後に大腸内視鏡検査を行ったところ、病状の改善が認められた。大腸内視鏡検査の3日後に腹痛を訴えて救急外来を受診した．腹部CT検査では骨盤腔内に腔外空気充填腔を認めた。小腸穿孔と診断し，緊急開腹手術と小腸切除を伴う右血行再建術を施行した．本報告では抗結核薬に対する逆説的反応として腸管穿孔を呈した1例を報告し、簡単な文献レビューを行った。
Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular, and provides a brief literature review.