リンパ濾胞増殖症から典型例に進展した潰瘍性大腸炎の1例

A Case of the Ulcerative Colitis（UC）which Seemed to Progress from Lymph Folliculosis

要旨　初期病変としてのリンパ濾胞増殖症から，典型的な潰瘍性大腸炎に進展した症例を経験した．患者は47歳，女性．時折下血を自覚し，初診．理学的所見，臨床検査では著変はみられなかった．大腸内視鏡検査では，直腸下部にリンパ濾胞の増殖によると思われる大小の顆粒状隆起を，粘膜には一部発赤，黄色点を認めた．生検ではリンパ濾胞の過形成，一部炎症性細胞浸潤を認めたが，積極的に潰瘍性大腸炎を示唆する所見には乏しかった．クラミジア腸炎も疑ったが血清学的，組織学的には否定的であり，リンパ濾胞性直腸炎との鑑別が問題となった．約3か月のメサラジン，ステロイド坐剤による治療では内視鏡的には軽度改善したが，組織学的にはほぼ不変であった．さらに5か月の経過で血便が持続的となり，内視鏡的，組織学的にはリンパ濾胞の増殖は消褪し，典型的な潰瘍性大腸炎に進展した．

　A 47-year-old woman presented with complaints of anal bleeding. The physical and laboratory examinations were normal. Total colonoscopy showed large and small granular protruded lesions that seemed to be lymph folliculosis in the lower rectum and showed partial redness and scattered yellow spots in the rectal mucosa. Histological examination of the biopsy specimen from the rectum showed lymphoid follicular hyperplasia with partial inflammatory infiltration of the mucosa. Because the findings were not specific enough to reach a diagnosis of UC, it was necessary to differentiate the lesions from lymphoid follicular proctitis. Three months after medication of oral mesalazine（1,500mg/day）and Rinderon suppo.（1mg/day）, sigmoid colonoscopy（SCS）showed slight improvement of the rectal mucosa, but there were no significant changes in the histological findings. In addition, five months after the third examination, because she had complained of continued anal bleeding, we performed SCS. We obtained the typical endoscopic findings of the UC, and histological findings were compatible with UC such as cryptitis and diffuse inflammatory cell infilitration with disappearance of lymphoid follicular proliferation, with this evidence diagnosis of UC was made.