一過性に非乾酪性肉芽腫が確認されたリンパ濾胞過形成を伴う“アフタ様大腸炎”の1例

Enterocolitis with Diffuse Aphthous Lesions in which Noncaseating Granulomas were Demonstrated Transiently, Associated with Lymphoid Hyperplasia, Report of a Case

要旨　患者は32歳，男性．19歳ごろに内痔核の既往がある．25歳ごろから断続的な下痢，下腹部痛が出現．27歳初診時，炎症反応はみられなかったが，注腸X線検査で大腸全体に径2～4mmの透亮像が散在してみられ，大腸内視鏡検査では大腸全体および終末回腸に周囲に紅暈を伴う小アフタ様病変が多発し，一部びらん形成がみられた．病理組織学的に，炎症細胞浸潤と共に類上皮細胞から成る非乾酪性肉芽腫が確認された．整腸剤内服のみで経過観察したところ，10か月後にはびらんは消失し，アフタは減少，18か月後にはアフタも消失し，その後約3年間同様である．拡大内視鏡観察ではpit patternは保たれ，点在する微小隆起は組織学的にリンパ濾胞過形成を伴う慢性炎症像であった．本例はCrohn病との異同が問題となるが，確定診断には更なる経過観察ならびに症例の蓄積が必要である．

　We present a case of enterocolitis with multiple aphthous lesions in which noncaseating granulomas were demonstrated histologically. He had complained of diarrhea and abdominal discomfort for several years. In the laboratory examination, except for slight increase of serum immunoglobulins and the decrease of CD4+Leu8- cells in peripheral blood, there were no findings indicative of inflammation.

　Colonofiberscopic study showed multiple aphthous lesions throughout the terminal ileum and the entire colon, which showed noncaseating granulomas with cellular infiltration. He was treated by medication for his symptoms and, after a year, no aphthous lesions were found except for microelevation which, histologically, showed inflammatory change with lymphoid hyperplasia. Pit pattern of the colonic mucosa was shown to be normal by a dye-scattering, magnifying endoscope. In this case further observation of the clinical course is necessary for definite diagnosis of Crohn's disease. The meaning of colonic aphthous lesions in“colitis”and the problems involved in a definite diagnosis of Crohn's disease are discussed.