多彩な全身症状を呈した大腸Crohn病の非定型例の1例

Atypical Crohn's Colitis Presenting Various Extra-intestinal Complications, Report of a Case

要旨　患者は23歳の女性．発熱，下腹部痛，下痢を主訴に入院．S状結腸から横行結腸まで縦走配列傾向を持った不整形潰瘍がみられ，生検で肉芽腫が証明されたため，Crohn病と診断した．経腸栄養療法で緩解が得られたが，約3か月後に発熱，関節痛，結節性紅斑を伴って再燃した．再燃時には潰瘍は一部癒合し縦走潰瘍となっていた．本症例は，初診時はCrohn病としては非定型的な画像所見であったが，潰瘍の分布，性状を詳細に検討することで診断が可能であった．また，Crohn病の病勢に一致して多彩な全身性合併症が出現した興味深い症例であった．

　A 23-year-old woman was admitted to our hospital, complaining of watery diarrhea, lower abdominal pain and fever. Barium enema and colonoscopic examination in the first admission showed irregular-shaped discrete ulcers aligning with a longitudinal axis from the sigmoid to transverse colon. Although a longitudinal ulcer or cobblestone appearance was not found, non-caseating granulomas were demonstrated in the biopsy specimens of the stomach and colon, theraby, she was diagnosed with Crohn's disease. A four-week course of total enteral nutritional therapy healed the colonic ulcers and improve her general symptoms, she consequently entered a remission stage. After three months of home remedy, she developed lower abdominal pain and diarrhea, accompanied by various extra-intestinal symptoms and signs including high fever, joint pain and erythema nodosum of the lower legs. Colonoscopic examination at second admission showed that discrete ulcers aligning with a longitudinal axis were partially fused and formed longitudinal ulcers in the sigmoid colon. X-ray and endoscopic findings of the initial examination were atypical as Crohn's disease, but distribution and appearance of the colonic ulcers suggested Crohn's disease. In a recurrent phase, various general complications appeared and were accompanied by formation of a typical longitudinal ulcer which was characteristic of Crohn's disease.