大腸結核との鑑別が問題となった大腸Crohn病の1例

Crohn's Colitis Which was Difficult to Exclude Colonic Tuberculosis, Report of a Case

要旨　患者は66歳，女性．主訴は腹部膨満感と軟便である．前医でCrohn病と診断され治療を受けていた．当科受診時には既に緩解期となっていたが，萎縮した大腸粘膜からの生検で，Crohn病に特徴的な非乾酪性，萎縮性の肉芽腫が認められた．しかし注腸，内視鏡検査では，下行結腸から上行結腸にかけての腸管短縮と炎症性ポリープ，粘膜橋の多発，盲腸変形，回盲部狭窄などが認められ，活動期には一部輪状傾向を有する潰瘍もみられた．更にツベルクリン反応中等度陽性であったことも合わせ考えると，Crohn病よりは，むしろ大腸結核が疑われた．しかし，本症例の場合，前医での十分量のステロイド投与が著効を示したことから，最終的に大腸Crohn病と診断された．

　A 66-year-old woman visited our hospital with complaints of abdominal fullness and soft stool. She was diagnosed with Crohn's disease and treated by the previous hospital. Barium enema and colonoscopic examinations showed marked shortening of the colon, inflammatory polyps, mucosal bridges, deformity of the cecum, stricture of the ileo-cecal region, and circular-shaped ulcers. Furthermore, tuberculin test was moderately positive. These findings suggested the colonic tuberculosis. On the other hand, non-caseating and atrophic granuloma which were characteristic of Crohn's disease, were seen in the biopsy specimens at our hospital. Finally, we diagnosed her with Crohn's colitis, because steroid hormones given by the previous doctor were very effeceive.