長期間にわたってアフタ様病変がみられたCrohn病の1例

Crohn's Disease with Only Aphthoid Lesions Which Persisted Unchanged for a Long Period, Report of a Case

要旨　患者は15歳，男性．泥状下痢便を主訴に来院．初回消化管X線・内視鏡検査で直腸から下行結腸，横行結腸，回盲弁，回腸に多発するアフタ様病変を認めた．感染性腸炎が否定され，大腸生検により非乾酪性肉芽腫を認め，アフタ様病変のみの小腸・大腸型Crohn病と診断した．初診時から2年間は半消化態栄養療法のみを施行したが，アフタ様病変が消褪しないため，その後ステロイド療法を併用した．臨床症状は改善したにもかかわらず，3年6か月間にわたりアフタ様病変は不変であった．本症例のようにアフタ様病変が長期間観察され不変であった，という報告は少なく，Crohn病の自然史を考えるうえで興味深い症例であると考えられた．

　A 15-year-old male patient visited our hospital complaining of loose stool. Radiological and endoscopic examinations disclosed multiple aphthoid lesions from the rectum to the descending colon, on the ileocecal valve and in the ileum. Since infectious causes were disproved and biopsy revealed the presence of non-caseating granulomas, this case was diagnosed as Crohn's disease with only aphthoid lesions involving both small and large intestine. Defined formula diet was administered for two years, but the lesions were unchanged. Accordingly, steroid therapy was also started. As a result, clinical symptoms ameliorated, however, the aphthoid lesions persisted unchanged for the total follow-up period of over three and a half years. Reports of similar cases are rare, and this case was considered important in speculating the natural course of Crohn's disease.