経過中に大腸型Crohn病から潰瘍性大腸炎に診断が変更になったIBDUの1例

Inflammatory Bowel Disease Unclassified Whose Diagnosis was Changed from Colonic Crohn's Disease to Ulcerative Colitis During the Course of the Disease, Report of a Case

要旨●患者は20歳代，男性．腹痛，下痢を主訴に受診した．初診時に著明な貧血を呈しており，大腸内視鏡検査で下行結腸〜上行結腸にかけて縦走潰瘍，上行結腸に敷石像を認め大腸型CDと診断され，加療を受け軽快していた．約1年後に血便を認めるようになり大腸内視鏡の再検を受けた．直腸〜下行結腸のhaustraは消失し，びまん性・連続性に発赤粗糙・細顆粒状粘膜を認め，UCに典型的な所見を呈していた．横行結腸以深の血管透見像は良好で肉眼的には正常であったが，上行結腸の生検で非乾酪性類上皮細胞肉芽腫が検出され，IBDUと診断した．その後は肉芽腫が検出されることはなく，UCに矛盾しない臨床像で現在まで経過している．

　A male patient in his 20s presented with chief complaints of abdominal pain and diarrhea. An initial examination revealed severe anemia, and colonoscopy showed a longitudinal ulcer extending from the descending colon to the ascending colon. The ascending colon had a cobblestone appearance ; therefore, he was diagnosed with colonic Crohn's disease. Approximately 1 year later, he started passing bloody stools and underwent a repeat colonoscopy. The examination revealed the disappearance of haustra from the rectum up to the splenic flexure and a diffuse continuous erythematous mucosa with coarse and fine granularity was observed, which was typical of UC（ulcerative colitis）. A biopsy examination of the ascending colon revealed a non-desmoplastic epithelioid cell granuloma, and the patient was diagnosed with inflammatory bowel disease unclassified. Ever since, the clinical course has been consistent with UC.