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Crohn's Disease Followed up for Four Years and Six Months with Only Aphthoid Lesions at the Onset, Report of a Case Hiroshi Nakano 1 , Nobuo Yagi 1 , Masaki Hokama 1 1Department of Internal Medicine, School of Medicine, Fujita Health University Keyword: Crohn病 , アフタ様病変 pp.575-582
Published Date 1994/5/25
DOI https://doi.org/10.11477/mf.1403105804
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 A 51-year-old woman presented complaints of throat pain, fever and diarrhea. Anal fissures were found in the rectal examination. Laboratory examinations revealed leucocytosis (13,200/μl), slight anemia (Hb 9.1 g/dl), hypoalbuminemia (2.7 g/dl), positive CRP and elevated erythrocyte sedimentation rate.

 Initial barium enema showed numerous aphthoid ulcers and discrete ulcers scattered throughout the colon had spared the rectum and the cecum. X-ray examination of the small intestine demonstrated aphthoid ulcers in the distal ileum. Colonoscopy showed aphthoid ulcers on the mucosal surface of the colon. Histological examination of the biopsy specimen from the sigmoid colon showed non-caseating epithelioid cell granuloma.

 The patient was treated with elemental diet alimentation and administration of prednisolone and salazosulfapyridine. The clinical symptoms disappeared rapidly and laboratory data improved to normal. Repeated barium enema nine weeks after the initial examination showed only scars with mucosal convergency and inflammatory polyposis. The next barium enema eight months later showed enlarged lymph follicles scattered throughout the entire colon, and two years later, the same findings were observed. The last radiological examinations, four years and six months after the initial examinaton, showed the recurrence of aphthoid ulcers in the colon. X-ray of the small intestine revealed characteristic findings of Crohn's disease such as longitudinal ulceration and eccentric rigidity.

 In this case, just as in other reported cases, the radiographic evidence suggests that a reactivation of quiescent Crohn's disease was heralded by a reoccurrence of aphthoid ulcers.


Copyright © 1994, Igaku-Shoin Ltd. All rights reserved.

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