山梨医科大学雑誌　第3巻3号　125-130(1988)

＜症例報告＞アメーバ性肝膿瘍の1例

佐野主一，立川博邦，木之瀬正，相野田隆雄，
宮崎吉規，山本安幸，池田昌弘，赤羽賢浩，
藤野雅之，鈴木　宏

抄　録：症例は58歳男性，海外渡航歴なし。右側腹部痛，発熱を主訴に昭和60年10月当科入院。入院時検査所見では WBC 28300，CRP 6(+)，梅毒反応陽性，HBs抗体陽性であった。US，CTで，肝右葉に径7cmと4cmの中心部壊死を思わせる局在性病変を認め，肝膿瘍と診断。ドレナージ施行。膿汁の鏡検でEntamoeba histolyticaを確認。内視鏡検査にて腸管病変は確認し得なかったが，糞便の鏡検でも同様の原虫を認めた。このため metronidazole 1500mgを18日間，tinidazole 2000mgを11日間投与した結果自覚症状は消失し，白血球数も正常化し，CT上膿瘍腔の縮小化も認めた。現在は再発なく外来通院中である。近年アメーバ性肝膿瘍は男性同性愛者に多発すると報告されているが，本例では確認し得なかった。

キーワード　アメーバ性肝膿瘍



A Case of Amoebic Abscess of the Liver

Shuichi Sano, Hirokuni Tachikawa, Tadashi Kinose, Takao Ainota,
Yoshiki Miyazaki, Yasuyuki Yamamoto, Masahiro Ikeda, Yoshihiro Akahane,
Masayuki A. Fujino, and Hiroshi Suzuki

A 58-year-old male was hospitalized with right hypochondralgia and remittent fever in October, 1985. The patient had no history of overseas travel. The abnormal laboratory findings on admission were as follows: Marked leukocytosis with neutrophilia (28,300/mm3), CRP 6+, anti-HBs positive, TPHA ×2,560. Serum albumin was 2.4 g/dl, serum Fe was 14 μg/dl. Biliary tract enzymes, and transaminase levels were moderately elevated. Two space occupying lesions of 7 cm and 4 cm in diameter were noted in the liver by ultrasonography (US) and CT scan. Abscesses were suspccted, and US-guided drainage was performed, yielding pus. Entamoeba histolytica was detected in the pus and also in feces. No abnormal findings, however, were noted in the large intestine by colonoscopy. Metronidazole 1.5 g/day was administered for 18 days in combination with antibiotics, followed by Tinidazoe 2.0 g/day for 11 days. After these treatments, the symptoms disappeared and reduction of the abscess cavities was also noted. Recent reports show an increasing incidence of amoebic abscess of the liver among Japanese male homosexuals, but it was not confirmed whether this patient was homosexual or not.

Key word: amoebic liver abscess



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