アフタ様病変のみから成るCrohn病の1例―5年間の経時的推移

Crohn's Disease Presenting Solely Aphthous Lesions and Their Sequential Changes, Report of a Case

要旨　アフタ様病変のみから成るCrohn病症例の5年間の経過を報告する．患者は16歳，男性．1988年4月，腹痛，下痢，体重減少を主訴に来院．軽度の炎症所見を認め，X線検査で胃，十二指腸，小腸，大腸に径2mmまでのバリウム斑を有するアフタ様病変を認めた．各部位からの生検組織から非乾酪性肉芽腫が検出され，Crohn病と診断した．入院後10週間の中心静脈栄養療法で自覚症状，炎症所見は消失し，アフタ様病変も著明に改善した．以後，外来で半消化態栄養剤の投与を行い，ほぼ臨床的緩解は維持されていたが，1年3か月後に十二指腸，2年後に小腸，2年6か月後に胃，3年11か月後には大腸にアフタ様病変の再発が認められた．

　A 16-year-old male was admitted to our hospital with complaints of abdominal pain and diarrhea for eight months. Initial radiography and endoscopy showed widespread tiny aphthous erosions throughout the gastrointestinal tract, where non-caseating epithelioid cell granulomas were identified in biopsy specimens, except in those from the esophagus. Therefore, we diagnosed the patient as suffering from Crohn's disease. Ten weeks after total parenteral nutrition therapy, his symptoms were resolved, and, on follow-up examination, the aphthous lesions disappeared. Thereafter, he was treated with low residue diet (Clinimeal®) as an out-patient for about five years. Although his clinical course has remained in remission, aphthous lesions have recurred in the duodenum after 1.3 years, in the jejunum and ileum after 2 years, in the gastric antrum after 2.5 years, and in the colorectum after 3.9 years.