血尿を初発症状として発症したビルハルツ住血吸虫症の1例

Abstract

31歳男.2年間のアフリカ・南米・中近東旅行から帰国後, 肉眼的血尿, 排尿障害を自覚した.アフリカ滞在中, マラウィ湖で遊泳をしたことがあった.超音波検査, 膀胱鏡検査では, 膀胱に, 黄白色の腫瘤性病変を多数認めた.検尿で特異的虫卵を認め, ビルハルツ住血吸虫症を疑った.経尿道的に膀胱内腫瘤を切除した.組織標本には住血吸虫卵を中心に多数の肉芽腫性, 炎症性変化を認め, ビルハルツ住血吸虫症と診断した.praziquantelの2日間投与により肉眼的血尿は速やかに消失し, 尿中ビルハルツ住血吸虫卵も減少した.治療後1年経過現在, 変性した虫卵が微量に検出されているが, 再発の徴候はない

A 31-year-old Japanese man who had been in Africa for two years presented with gross hematuria. He had been swimming in Lake Malawi during this period. Urinary specimen consisted of hematuria and pyuria. Cystoscopy showed tumors resembling Bilharzial tubercles located in the trigone, left lateral and posterior wall and dome. Further urine examination demonstrated eggs of schistosome haematobium. The patient was highly suspected of having Bilharzial schistosomiasis in the urinary bladder. Transurethral resection of bladder tumors was performed for diagnosis. Pathological examination revealed granuloma with many eggs of schistosome haematobium. He was diagnosed with Bilharzial schistosomiasis and was treated with 3, 600 mg of praziquantel daily for two days. There have been no signs of recurrence during the one-year follow up except for excretion of degenerated eggs of schistosome haematobium in the urine specimens.