アフタ様病変で発症し，典型例に進展したCrohn病の1例

Crohn's Disease Presenting Solely Aphthoid Lesions, Report of a Case

要旨　患者は17歳，男性．下痢，発熱を主訴に入院した．初診時消化管X線ならびに内視鏡検査で食道から直腸までのほぼ全消化管に散在するアフタ様病変を認めた．食道，胃，大腸からの生検で非乾酪性類上皮細胞性肉芽腫が認められ，Crohn病と診断した．半消化態栄養剤の投与で臨床所見と腸管病変の改善を認めた．その後も半消化態栄養剤の投与を継続していたが，1年6か月後に回腸に縦走潰瘍を認めた．

　A 17-year-old man visited our hospital because of diarrhea and fever. Initial roentgenographic and endoscopic examinations revealed multiple aphthoid lesions in the esophagus, stomach, duodenum, small intestine, and colon. Histological examination of the biopsy specimens from the esophagus, stomach, and colon showed non-caseating epithelioid cell granulomas, suggesting Crohn's disease. The patient was treated with defined formula diet, resulting in an improvement of symptoms and a diminishment of aphthoid ulcers. While he continued receiving nutritional treatment thereafter, follow-up roentgenographic and endoscopic examinations performed one year and six months later revealed longitudinal ulcers in the ileum. It is suggested that aphthoid ulcers may be an early macroscopic feature of Crohn's disease and that nutritional treatment may not always prevent them from developing into longitudinal ulcers.