cobblestone-like appearanceを呈した大腸結核の1例

Colonic Tuberculosis Showing Macroscopically Cobblestone-like Appearance, Report of a Case

要旨　患者は43歳，女性．主訴は発熱，水様性下痢．約2か月間近医で対症療法を受けていたが，低蛋白血症，貧血を呈するようになり，当科紹介入院となった．注腸造影・大腸内視鏡検査では上行結腸に潰瘍を伴うcobblestone-like appearanceを認め，横行結腸にskip lesionを認めた．Crohn病を疑いIVHおよびSalazopyrin投与で加療したが病状の改善を認めなかった．1か月後，2回目の大腸内視鏡検査での生検で乾酪性肉芽腫を認め，大腸結核と確診した．抗結核剤の投与により，臨床症状および注腸・内視鏡像は改善した．本症例はcobblestone-like appearanceを認め，Crohn病と大腸結核を鑑別するうえで示唆に富む症例であると考えられた．

　A 43 year-old woman whose chief complaint was high fever and watery diarrhea was admitted to our hospital. Radiological and colonoscopic examination revealed remarkable cobblestone-like appearance and multiple small ulcers in the ascending colon. After diagnosing Crohn's disease, we treated the patient by IVH and Salazopyrin. However, her symptoms and laboratory data did not improve. Histologic examination of biopsy specimen was during reexamination of colonoscopy showed caseous granuloma and was diagnosed as colonic tuberculosis. After anti-tubercular therapy was performed, her symptoms and laboratory data improved. Furthermore, cobblestone-like appearance disappeared. This case was thought to be very important for making a differential diagnosis between Crohn's disease and colonic tuberuculosis.