A case of amebic liver abscess in a homosexual patient with human immunodeficiency virus(HIV)infection

症例は40代男性.入院2週間前から心窩部痛,背部痛を生じ,1週間前より微熱,全身倦怠感も伴うようになった.その後,40℃の発熱を来たし,体動困難となったため,救急車で当院搬送となった.来院時,心窩部で肝臓を触知,軽度の圧痛を伴っていた.血液検査では高い炎症所見と軽度の肝酵素の上昇を認めた.腹部造影CT検査で肝左葉に70㎜大の境界明瞭,分葉形の低吸収域を認め,肝膿瘍と考えられた.経皮経肝膿瘍ドレナージを行い,赤褐色調の排液を認めた.細菌性肝膿瘍を考えセフメタゾール投与を開始したが,３日後にも解熱しないため,アメーバ性肝膿瘍を疑いメトロニダゾール2g/日の経口投与を開始,翌日から速やかに解熱した.肝膿瘍内容液の培養では赤痢アメーバを検出できなかったが,血清抗体検査でアメーバ性肝膿瘍の診断に至った.入院24日目に施行したCT検査では膿瘍腔はほぼ消失していたため,ドレーンを抜去,入院33日目に軽快退院となった.入院中に施行したHIVスクリーニング検査の結果は陽性で,また患者本人から男性同性愛者であるとの情報が得られた.肝膿瘍の原因として赤痢アメーバを鑑別に挙げることは重要であるが,男性同性愛者にみる腸管感染症(Gay bowel syndrome)からHIVの可能性を考え,未診断のHIVを拾い上げる努力が,さらに重要なことと考えられた.

A man in his 40's was transferred to our hospital by ambulance because of high fever and immobility. The patient has been well until two weeks earlier, when he began to have epigastralgia and back pain, followed by fever, diarrhea and general fatigue. Laboratory tests showed marked inflammatory reactions and mild elevation of hepatobilliary enzymes. A computed tomography of the abdomen revealed a 70mm-diameter, well-defined and lobulated low density area in the left hepatic lobe, which was consistent with hepatic abscess. We performed percutaneous abscess drainage and aspirated red-brown fluid. Although cefmetazole was given intravenously, the patient’s temperature rose to 38.0 or higher during the first 3days of hospitalization. So we added oral metronidazole on the third day. His temperature reduced on the fourth day, and didn’t rise after that. Although microbiologic evaluation of stool and aspirated specimen from liver abscess was negative, test for antibodies to Entamoeba was positive. He was discharged on the 33rd hospital day. The patient was confirmed as being HIV-positive by serological tests. We referred him to a specialist for treatment of HIV.

アメーバ性肝膿瘍

HIV感染症

男性同性愛者