過敏性血管炎による腸病変の1例

Hypersensitivity Angitis with Intestinal Involvements, Report of a Case

要旨　患者は27歳の男性．発熱，下痢，関節痛，皮疹を主訴に入院．左側結腸にdiscrete ulcerの多発，右側結腸にアフタ様潰瘍，回腸末端部の腸間膜付着側を中心に裂溝潰瘍を伴った縦走潰瘍を認め，Crohn病が疑われた．しかし，ステロイド投与により上記所見が4週で治癒したこと，これまで4回の再発・緩解を繰り返しているにもかかわらず腸管の変形が軽度であること，腸症状のない再発が認められること，組織学的に肉芽腫が認められないこと，がCrohn病としては非典型的であった．皮疹からの生検で細動脈に壊死性血管炎の所見を認めたことを糸口にして，臨床経過を総合し，本例を過敏性血管炎による腸病変の1例と診断した．

　A 27-year-old male was admitted to our hospital because of fever, diarrhea, arthralgia and eruption. Radiologic and endoscopic examinations showed multiple discrete ulcers in the left side colon, several aphthoid ulcers in the right side colon and longitudinal ulcers with fissure in the terminal ileum, mainly along the mesenteric attachment. Crohn's disease was suspected from these findings. However, clinical course and histological findings as follows were not typical for Crohn's disease. First, ulcers healed in only 4 weeks after steroid administration was started. Second, although relapse and remission were repeated four times, deformity of the intestinal tract was mild. Third, relapse occurred without causing symptoms of intestinal tract. Finally, epithelioid cell granuloma was not found histologically. Biopsy specimen obtained from eruption, revealing necrotizing angitis in the arterioles, gave us a clue to the correct diagnosis in this case. Thus, clinical findings and course in this case represent intestinal involvement in hypersensitivity angitis.