食道Behcet潰瘍と考えられた1例

Behcet's Disease with an Esophageal Ulcer, Report of a Case

要旨　症例は59歳，女性．食事嚥下時の違和感を主訴に近医受診し，食道腫瘍を指摘され，当院に紹介となった．当院での;上部消化管内視鏡検査では0-III型癌類似の病変を認めたが，食道悪性腫瘍としては柔らかい印象であり，生検組織検査では非特異的炎症と診断された．問診より口腔内アフタの出現と消失が以前よりあったことから，食道Behcet潰瘍と考えた．Behcet病の認定基準では"疑い症例"となり，HLA-B51は陰性であった．診断的治療としてprednisoloneの投与を行ったところ，6か月後には完全に治癒・瘢痕化に至った．それ以後食道に潰瘍の再燃を認めていないが，Behcet病は急性炎症を繰り返す疾患として特徴づけられており，注意深い経過観察が必要である．

　A 59-year-old female consulted a local doctor complaining of discomfort while swallowing during meals. The physician suggested the possibility of an esophageal tumor following which she visited our hospital for further tests. On performing upper gastrointestinal endoscopy, we detected a lesion resembling 0-III type cancer. Biopsy results revealed the lesion to be a non-specific inflammatory infiltrate. Because she had a history of intermittent episodes of oral aphtha and the esophageal ulcers without malignancy, we suspected that she suffered from Behcet's disease. HLA-B51 was negative, and she met diagnostic criteria for a "suspected case"of behcet's disease. Steroid therapy was performed as a diagnostic therapy. After six months of treatment, the ulcer seemed to be completely cured with minimal scarring, and there have been no instances of recurrent esophageal ulcers. Hence, we believe that it is necessary to conduct careful follow-up sessions with patients with recurring acute inflammatory episodes.