Behçet病患者に認められた腸管の炎症性病変

Inflammatory Bowel Lesion Associated with Behçet Disease

要旨　患者は29歳，男性．右下腹部痛と粘血便を主訴として入院，現症で顔面躯幹の毛囊炎様皮疹，下口唇のアフタ性潰瘍，陰囊部有痛性潰瘍，両膝関節痛，左第4指膿皮症を認めた．臨床検査所見ではWBC14,900/mm³，血沈1時間値100mm，CRP6(＋)以外に著変なく，ツ反，血清アメーバ抗体は陰性であった．X線所見では直腸に辺縁不整，全体に凹凸があり，横行結腸中央部に2個のニッシェが，そして，横行結腸口側1/3から盲腸までは直腸と同様の変化がみられた．内視鏡検査でもX線所見と一致した部位に潰瘍性病変を認め，下掘れの強い潰瘍やmucosal bridgeも認めた．病変部の生検組織には陰窩膿瘍や肉芽腫を認めなかった．salazopyrinの内服で臨床症状は改善し，X線・内視鏡所見でも潰瘍は消失し，炎症性ポリープの出現をみた．本例は不全型のBehçet病を有し，腸病変は潰瘍性大腸炎やCrohn病とは一致せず，Behçet病患者に認められた本邦ではまれな型の腸管の炎症性病変と考えられた．

　A 29 year-old man was admitted to our hospital on February 18, 1981 with chief complaints of right lower abdominal pain and mucous bloody stool. He had acneiform skin eruption on the face and body, aphthous ulcer on the lower lip, painful ulcers on the scrotum, arthralgia on both knees and pyoderma gangreonosum on the left ring finger. Laboratory examinations showed leukocytosis, acceleration of ESR, and strongly positive CRP and the others were almost normal. Tuberculin reaction and serum amebic antibody were negative. Barium enema showed slight narrowing of the lumen, coarse irregular contour, and granular mucosal pattern in the rectum, right side colon and cecum. Colonoscopic picture showed deep ulcers and mucosal bridges in the rectum and multiple ulcers continuously in the right side colon. After medication of salicylazosulfapyridine, decrease of bowel movement, increase of body weight and improvement of ESR were seen, and in barium enema and colonoscopy ulceration was disappeared and only inflammatory polyps and mucosal bridges were shown. This case was incomplete Behçet disease but bowel lesion was slightly different from that of usual intestinal Behçet in Japan. However, as it was not compatible with ulcerative colitis, Crohn's disease and other inflammatory disease, this case was thought to be inflammatory bowel lesion associated with Behçet disease.