食道病変を中心に発症したアフタ様病変のみのCrohn病の1例

Crohn's Disease with Solely Aphthoid Lesions, Developing from Esophageal Aphthoid Lesions, Report of a Case

要旨　患者は24歳，女性．咽頭痛，嚥下時の胸のつかえ感と発熱を主訴に来院した．上部消化管内視鏡検査で食道全域に及ぶアフタ様病変を認め，下部消化管内視鏡で回腸終末部および大腸全域に微小なアフタ様病変を認めた．いずれの生検組織にも非乾酪性類上皮細胞肉芽腫を認め，食道病変を中心に発症したアフタ様病変のみのCrohn病と診断した．入院後，栄養療法を含め無治療で症状は消失し，また食道のアフタ様病変は治癒傾向を示したが，大腸のアフタ様病変はほとんど変化せず現在まで経過している．臨床経過から考えて，単純ヘルペス感染症が本例の発症の契機になった可能性も示唆され，アフタ様病変のみのCrohn病の経過を考えるうえで，非常に興味あるまれな症例である．

　A 24-year-old woman was admitted to our hospital complaining of a sensation of food sticking in her chest, high fever and sore throat. Upper gastrointestinal endoscopic examination and colonoscopic examination revealed aphthoid lesions throughout the whole esophagus and small ones throughout the colon including the terminal ileum. The biopsy specimens from the esophageal and colonic aphthoid lesions revealed the presence of non-caseatining epithelioid cell granulomas, diagnosed as Crohn's disease with solely aphthoid lesions developing from the esophageal aphthoid lesions. In a few days the clinical symptoms disappeared with no treatment or nutritional therapy and the aphthoid lesions of the esophagus appeared to be healing. Until now, the lesions of the colon have not changed significantly. The clinical course suggests that this case may have been caused by HSV infection. This rare case is very interesting for speculating the course of Crohn's disease presenting solely aphthoid lesions.