Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Gastric Low-grade MALT Lymphoma Induced by a Helicobacter heilmannii-like Organism

Helicobacter heilmannii -like Organism으로 유발된 저등급 위 MALT 림프종 1예

  • Oh, Dong-Hoon (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Nam-Hoon (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Cho, Yu-Jung (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Song, Tae-Jun (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Bae, Won-Ki (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Kyung-Ah (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, June-Sung (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Joo, Mee (Department of Pathology, Ilsan Paik Hospital, Inje University College of Medicine)
  • 오동훈 (인제대학교 의과대학 일산백병원 내과학교실) ;
  • 김남훈 (인제대학교 의과대학 일산백병원 내과학교실) ;
  • 조유정 (인제대학교 의과대학 일산백병원 내과학교실) ;
  • 송태준 (인제대학교 의과대학 일산백병원 내과학교실) ;
  • 배원기 (인제대학교 의과대학 일산백병원 내과학교실) ;
  • 김경아 (인제대학교 의과대학 일산백병원 내과학교실) ;
  • 이준성 (인제대학교 의과대학 일산백병원 내과학교실) ;
  • 주미 (인제대학교 의과대학 일산백병원 병리학교실)
  • Published : 2011.07.30
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Abstract

Helicobacter heilmannii is a Gram negative, long spiral-shaped organism associated with zoonotic infections acquired from primates including cats and dogs. Infection with H. heilmannii leads to gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. We experienced a 54-year-old man with dyspepsia who was diagnosed with primary gastric MALT lymphoma (stage IE1) associated with a H. heilmannii-like organism. Upper gastrointestinal endoscopy revealed only microvascular dilatation and mucosal granularity without elevated or ulcerative lesions at the stomach angle. He was probably infected by a pet dog. The man was treated with eradication therapy for 2 weeks including lansoprazole, amoxicillin, and clarithromycin. Four weeks after eradication of the H. heilmannii-like organism, follow-up endoscopy and pathological biopsy findings showed complete remission of the gastric MALT lymphoma.

헬리코박터 헤일마니는 양극성 편모를 가지는 그람음성 나선균의 형태를 띠고 요소분해효소를 가지는 헬리코박터 종의 한 종류로서 개와 고양이 등의 애완동물들로부터 인간에게 감염을 유발한다. 헬리코박터 헤일마니는 헬리코박터 파일로리에 비해 매우 낮은 인체 감염율을 나타내지만 위점막의 염증성 변화를 일으킴으로써 위염, 소화성 궤양, 위 말트림프종 등이 발생할 수 있다. 1개월간의 소화불량으로 내원한 54세의 남자에서 상부위장관 내시경검사를 시행하였고 위각부에 나선형태의 미세혈관 확장과 점막의 과립상의 소견이 관찰되었다. 병리조직검사를 통해 저등급 위 말트림프종과 헬리코박터 헤일마니 유사균주를 진단하였고 요소호기검사 양성이었다. 환자는 진돗개를 키우고 있었으며 이로 인한 감염으로 생각하며, 2주 간의 제균요법과 함께 4주 뒤 그리고 2개월 뒤의 추적 내시경검사에서 완치를 확인한 증례를 경험하여 문헌고찰과 함께 보고한다.

Keywords

References

  1. Parsonnet J, Friedman GD, Vandersteen DP, et al. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med 1991;325:1127-1131. https://doi.org/10.1056/NEJM199110173251603
  2. Wotherspoon AC, Ortiz-Hidalgo C, Falzon MR, Isaacson PG. Helicobacter pylori-associated gastritis and primary B-cell gastric lymphoma. Lancet 1991;338:1175-1176. https://doi.org/10.1016/0140-6736(91)92035-Z
  3. Eaton KA, Dewhirst FE, Paster BJ, et al. Prevalence and varieties of Helicobacter species in dogs from random sources and pet dogs: animal and public health implications. J Clin Microbiol 1996;34:3165-3170.
  4. Heilmann KL, Borchard F. Gastritis due to spiral shaped bacteria other than Helicobacter pylori: clinical, histological, and ultrastructural findings. Gut 1991;32:137-140. https://doi.org/10.1136/gut.32.2.137
  5. Hilzenrat N, Lamoureux E, Weintrub I, Alpert E, Lichter M, Alpert L. Helicobacter heilmannii-like spiral bacteria in gastric mucosal biopsies. Prevalence and clinical significance. Arch Pathol Lab Med 1995;119:1149-1153.
  6. Andersen LP, Norgaard A, Holck S, Blom J, Elsborg L. Isolation of a "Helicobacter heilmannii"-like organism from the human stomach. Eur J Clin Microbiol Infect Dis 1996;15:95-96. https://doi.org/10.1007/BF01586196
  7. Jhala D, Jhala N, Lechago J, Haber M. Helicobacter heilmannii gastritis: association with acid peptic diseases and comparison with Helicobacter pylori gastritis. Mod Pathol 1999;12:534-538.
  8. Okiyama Y, Matsuzawa K, Hidaka E, Sano K, Akamatsu T, Ota H. Helicobcater heilmannii infection: clinical, endoscopic and histological features in Japanese patients. Pathol Int 2005;55:398-404. https://doi.org/10.1111/j.1440-1827.2005.01844.x
  9. Joo M, Kwak JE, Chang SH, et al. Helicobacter heilmanniiassociated gastritis: clinicopathologic findings and comparison with Helicobacter pylori-associated gastritis. J Korean Med Sci 2007;22:63-69.
  10. Morgner A, Bayerdorffer E, Meining A, Stolte M, Kroher G. Helicobacter heilmannii and gastric cancer. Lancet 1995;346:511-512.
  11. Thomas-Marques L, Yaziji N, Bouche O, Diebold MD, Cadiot G, Thiefin G. Helicobacter heilmannii-associated low-grade gastric MALT lymphoma: a new case of complete remission after eradication. Gastroenterol Clin Biol 2005;29:476-477. https://doi.org/10.1016/S0399-8320(05)80823-1
  12. Regimbeau C, Karsenti D, Durand V, et al. Low-grade gastric MALT lymphoma and Helicobacter heilmannii (Gastrospirillum hominis). Gastroenterol Clin Biol 1998;22:720-723.
  13. Stolte M, Wellens E, Bethke B, Ritter M, Eidt H. Helicobacter heilmannii (formerly Gastrospirillum hominis) gastritis: an infection transmitted by animals? Scand J Gastroenterol 1994;29:1061-1064. https://doi.org/10.3109/00365529409094888
  14. Hwang CY, Han HR, Youn HY. Prevalence and clinical characterization of gastric Helicobacter species infection of dogs and cats in Korea. J Vet Sci 2002;3:123-133.
  15. Morgner A, Lehn N, Andersen LP, et al. Helicobacter heilmannii- associated primary gastric low-grade MALT lymphoma: complete remission after curing the infection. Gastroenterology 2000;118:821-828. https://doi.org/10.1016/S0016-5085(00)70167-3
  16. O'Rourke JL, Dixon MF, Jack A, Enno A, Lee A. Gastric B-cell mucosa-associated lymphoid tissue (MALT) lymphoma in an animal model of 'Helicobacter heilmannii' infection. J Pathol 2004;203:896-903. https://doi.org/10.1002/path.1593
  17. Nakamura M, Takahashi S, Matsui H, et al. Microcirculatory alteration in low-grade gastric mucosa-associated lymphoma by Helicobacter heilmannii infection: its relation to vascular endothelial growth factor and cyclooxygenase-2. J Gastroenterol Hepatol 2008;23(suppl):157S-160S.
  18. Trebesius K, Adler K, Vieth M, Stolte M, Haas R. Specific detection and prevalence of Helicobacter heilmannii-like organisms in the human gastric mucosa by fluorescent in situ hybridization and partial 16S ribosomal DNA sequencing. J Clin Microbiol 2001;39:1510-1516. https://doi.org/10.1128/JCM.39.4.1510-1516.2001
  19. Matsui H, Aikawa C, Sekiya Y, Takahashi S, Murayama SY, Nakamura M. Evaluation of antibiotic therapy for eradication of "Candidatus Helicobacter heilmannii". Antimicrob Agents Chemother 2008;52:2988-2989. https://doi.org/10.1128/AAC.01662-07