長期経過中に大腿骨頭壊死を来したCrohn病の1例

Crohn's Disease Complicated by Femoral Head Necrosis Twenty Years After Onset, Report of a Case

要旨　患者は39歳の女性で，19歳のときに小腸大腸型Crohn病を発症した．37歳時の回盲部および回腸切除術後は在宅中心静脈栄養療法を行っていたが，嘔吐，腹痛，発熱が持続するため再入院した．ステロイド療法で症状が改善したため投与量を漸減中に右股関節痛が出現したが，単純X線，MRIでは異常を認めずCrohn病に合併する関節炎と診断した．NSAID（nonsteroid anti-inflammatory drug）が無効なため，ステロイドを増量したところ改善がみられた．再度ステロイドを漸減中に今度は左股関節痛が出現し，転倒を契機に痛みが増強し歩行不能となった．単純X線およびMRIで大腿骨頭の変形と広範な壊死を認めたため人工骨頭置換術を施行した．Crohn病における関節炎と大腿骨頭壊死について文献的考察を加え報告した．

　A case of 39-year-old female with Crohn's disease who developed femoral head necrosis was reported. She had been treated for Crohn's disease for twenty years. Two years after ileocecal and ileal resection had been performed, the patient continued to receive parentral nutrition. She was admitted again due to nausea and vomiting, abdominal pain and high fever. Steroid treatment was initiated, followed by amelioration of symptoms. Right coxalgia, however, developed during reduction of steroid dose. Plain x-ray and MRI were normal, and a diagnosis was made of Crohn's disease-associated arthritis. Since a non-steroidal anti-inflammatory drug was ineffective, the dose of steroid was increased again. Right coxalgia disappeared, and an attempt was made to gradually reduce the steroid dose. This time, left coxalgia developed, which was exacerbated following a fall. Plain x-ray and MRI revealed deformity and extensive necrosis of the left femoral head; prosthetic replacement was carried out.