アフタ様腸病変から典型像への進展を観察しえた左側大腸炎型潰瘍性大腸炎の1例

Aphthoid Proctitis Preceding the Development of Typical Lesions of Ulcerative Colitis, Report of a Case

要旨　患者は17歳，女性．下血を主訴に受診した．大腸内視鏡検査で下部直腸を中心に多発するアフタ様病変を認めた．7か月後には直腸病変はびまん性の顆粒状粘膜を示し，初診より1年9か月後には直腸から横行結腸遠位部まで連続する左側大腸炎型潰瘍性大腸炎に進展した．ステロイド剤で寛解となったが，3年9か月後に再燃，直腸は初回検査時に類似した小隆起の多発を伴うびまん性炎症を示した．本症例は潰瘍性大腸炎におけるアフタ様病変の意義を考えるうえで，示唆に富む症例と考えられた．

　A seventeen-year-old woman visited our hospital with a complaint of hematochezia. Colonocopy and barium enema revealed multiple aphthoid lesions mainly in the lower rectum. Histologic examination of the biopsy specimen showed moderate infiltrations of inflammatory cells with lymphoid follicle hyperplasia. These lesions subsequently became small and obscure, and seven months later, colonoscopy revealed diffusely granular mucosa in the rectum. One year and nine months after the first visit, barium enema showed diffuse granular mucosa extending continuously from the rectum to the distal portion of the transverse colon, a fact compatible with ulcerative colitis. Remission was induced by steroid therapy. Three years and nine months later, ulcerative colitis relapsed restrictedly in the rectum. Colonoscopy revealed multiple elevations similar to the initial lesion in the diffusely granular mucosa. This case seems to suggest that aphthoid lesion has a close relation to the onset and relapse of ulcerative colitis.