Crohn病・潰瘍性大腸炎両疾患の内視鏡所見が異時性にみられたIBDUの1例

Inflammatory Bowel Disease Unclassified with Endoscopic Findings of Crohn's Disease and Ulcerative Colitis, Report of a Case

要旨●患者は10歳代，男性．主訴は腹痛，下痢．大腸内視鏡検査で上行結腸から下行結腸にかけて粘膜浮腫と縦走潰瘍を，S状結腸には小潰瘍から不整形潰瘍を認めた．Crohn病と診断しインフリキシマブを導入し，アザチオプリンの投与を行うものの寛解維持が困難であり，経過観察の大腸内視鏡検査では終末回腸はやや粗糙で，また直腸から連続性に全大腸に粗糙粘膜，びらん，血管透見像の消失を認めた．回腸からの生検では非乾酪性類上皮細胞肉芽腫を，大腸からの生検では炎症細胞浸潤，陰窩炎，陰窩膿瘍および杯細胞の減少を認めた．異時性にCrohn病，潰瘍性大腸炎両者の内視鏡所見を，同時性に両者の病理組織像を認めたことから，IBDUと診断した．青黛の内服投与で寛解導入され，3年後の大腸内視鏡検査では粘膜治癒が確認された．

　A man in his 10s experiencing abdominal pain and diarrhea was admitted to our facility. CS（colonoscopy）showed mucosal edema and longitudinal ulcerations from the ascending colon to the descending colon, and small and irregular ulcerations in the sigmoid colon. He was diagnosed with Crohn's disease, and subsequently treated with 5-ASA, infliximab, and azathioprine. Follow-up CS revealed mucosal friability in the ileum, and continuous mucosal inflammation and loss of visible vascular pattern involving the lower rectum and extending to a point more proximal in the colon. Histological examination of the biopsy specimens from the ileum revealed granuloma, whereas that from the colorectum demonstrated diffuse inflammatory cell infiltration of the mucosa with crypt distortion and reduction of mucus-secreting goblet cells. We diagnosed the patient with unclassified inflammatory bowel disease based on the endoscopic and histological findings.