治療面からみた腸管Behçet病・単純性潰瘍の経過―ステロイドに反応せず，サリドマイド，インフリキシマブ投与が著効した腸管Behçet病の2例

The Clinical Efficacy of Thalidomide and Infliximab Therapy in Steroid Refractory Intestinal Behçet's Disease, Report of Two Cases

要旨　腸管Behçet病，単純性潰瘍は回盲部に打ち抜き潰瘍，あるいは下掘れ潰瘍と呼ばれる類円形の潰瘍を認め，病理組織像はほぼ同じ形態を示し鑑別に困難なことも少なくない．両者とも5-ASA製剤を基本薬として用い，中等症以上の症例ではステロイド大量投与が有効であるが，難治症例は手術となることが多く，術後の吻合部潰瘍も高率に認められる．最近，Behçet病においてもTNF-αの関与が示唆され，インフリキシマブの有効性が報告されている．今回，ステロイド大量投与に反応せず，サリドマイド，インフリキシマブ投与が著効した2例を経験したので報告する．

　Intestinal Behçet's disease and simple ulcers, which are frequently observed, are chronic relapsing diseases of unknown etiology. 5-ASA（aminosalicylic acid）derivatives, colchicine, corticosteroids immunomodulaters have been used in cases of both of these disease. TNF（tumor necrosis factor）-αis known to play an important role as part of the inflammatory cascade in intestinal Behçet's disease. Therefore, thalidomide which might decrease the production of TNF-α, and IFX（infliximab）, a monoclonal antibody to TNF-α, are considered effective drugs for active intestinal Behçet's disease. We describe two cases of steroid refractory intestinal Behçet's disease successfully treated with thalidomide and IFX therapy. Thalidomide and IFX are expected to be effective therapies for intestinal Behçet's disease, especially if more traditional medical therapy such as corticosteroids has not been successful.