壊疽性膿皮症を契機に診断され長期経過観察されたCrohn病の1例

Crohn's Disease Complicated by Pyoderma Gangrenosum, Report of a Case

要旨　患者は36歳，女性．20歳時より，腹痛，下痢が出現．24歳時より下腿伸側に有痛性紅斑の出没を繰り返していた．32歳時，左下腿伸側の膿庖を混じる紅斑が急速に潰瘍を形成したため当院皮膚科を受診，壊疽性膿皮症と診断された．この時点の消化管X線・内視鏡検査で大腸型Crohn病と確診された．36歳時に両下腿に壊疽性膿皮症が再発し，その後S状結腸穿孔，大腸小腸瘻，大腸子宮瘻，更に小腸皮膚瘻のため計3回の手術を受け，現在小腸大腸型Crohn病として経過観察されている．壊疽性膿皮症を合併するCrohn病は症例数が少なく，腸管病変と皮膚病変の長期経過は不明であるが，自験例では大腸病変の重症度と皮膚病変の活動性が相関していた．

　A 37-year-old female with Crohn's disease was admitted to our institution. At the age of 32 years, she was initially diagnosed as having Crohn's disease of colitis type complicated by pyoderma gangrenosum, and was later operated on because of perforation of the sigmoid colon. Six months after the surgery, she was again admitted, because of recurrence of pyoderma gangrenosum. At the time of admission, there were active lesions at the anastomosis of the colon. The pyoderma immediately responded to prednisolone and her intestinal lesions were treated by total parenteral nutrition. However, the Pyoderma gangrenosum later reoccurred when her Crohn's disease progressed to colo-ileal and colo-uteral fistulas which necessitated surgery. Of interest is the fact that the cutaneous lesions did not reoccur when her Crohn's disease developed in ileo-cutaneous fistulas. Our case suggests a close association between Pyoderma gangrenosum and severe inflammation of the colon in Crohn's disease.