腸結核との鑑別が問題となったCrohn病の1症例

Crohn's Disease in which Differential Diagnosis with Intestinal Tuberculosis was Difficult, Report of a Case

要旨　31歳，男性が下痢，腹痛，体重減少を主訴に入院した．大腸内視鏡では回盲弁の全周性潰瘍による狭窄と回盲弁周囲の多発性潰瘍がみられ，一部の潰瘍の横並び配列から腸結核を考えたが，生検で肉芽腫は証明できなかった．注腸X線では盲腸の狭窄，回盲弁周囲の多発性潰瘍，回腸終末部の多発性潰瘍・びらんと狭窄，および口側回腸にも潰瘍がみられたが縦走潰瘍や敷石像と読影できなかった．結核菌が証明されずPPD皮内反応も陰性であった．中心静脈栄養のみで症状が改善しないためステロイド治療を開始したところ速やかに病状は改善した．本例は診断基準に適合しないCrohn病症例と考えられた．非典型例を減らす方向での診断基準の見直しが望まれる．

　A case report of Crohn's disease in which differential diagnosis with tuberculosis was difficult. A 31-year-old male was admitted to our hospital complaining of diarrhea, abdominal pain, and body weight loss. Colonoscopy revealed multiple ulcers around the ileocecal valve, ulceration of the ileocecal valve with stenosis, and narrowing of the cecum. Histological examination of the biopsy specimens could not demonstrate granulomas. Barium enema x-ray disclosed a segment of stenosis with irregular contour and a skipped ulceration on the proximal side. Bacteriological studies were negative, and PPD skin test was also negative. Symptoms continued despite parenteral nutrition for two weeks and steroid therapy was started. Thereafter, symptomatic amelioration was observed in a short period. According to the diagnostic criteria of Crohn's disease, the demonstration of longitudinal ulcers, cobblestone appearance, or epithelioid granulomas are essential for diagnosis of Crohn's disease, but such findings were not demonstrated in this reported case. Improvement of the diagnostic criteria to include such atypical cases is desired.