Ishii Naoki, Furukawa Keiichi, Itoh Toshiyuki, Fujita Yoshiyuki
Department of Gastroenterology, St. Luke's International Hospital, Japan.
Intern Med. 2011;50(5):439-42. doi: 10.2169/internalmedicine.50.4634. Epub 2011 Mar 1.
A 39-year-old woman was referred to our hospital for treatment of a non-healing gastric ulcer. Esophagogastroduodenoscopy (EGD) revealed an erosion in the pyloric antrum and a longitudinal ulcer on the lesser curvature of the gastric body. The histopathologic examination of biopsy specimens revealed non-caseating epithelioid granulomas. Acid-fast staining did not reveal bacilli. The differential diagnosis included gastric tuberculosis, Crohn's disease, and sarcoidosis and empiric antituberculous therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide was initiated. Gastric lesions were subsequently resolved and non-caseating epithelioid granulomas were not demonstrated on the post-treatment examination. Recurrence was not observed during the follow-up period of 53 months.
一名39岁女性因胃溃疡不愈合被转诊至我院。食管胃十二指肠镜检查（EGD）显示幽门窦有糜烂，胃体小弯侧有纵行溃疡。活检标本的组织病理学检查显示非干酪样上皮样肉芽肿。抗酸染色未发现杆菌。鉴别诊断包括胃结核、克罗恩病和结节病，遂开始使用异烟肼、利福平、乙胺丁醇和吡嗪酰胺进行经验性抗结核治疗。胃病变随后消退，治疗后检查未发现非干酪样上皮样肉芽肿。在53个月的随访期内未观察到复发。
