初回発作時に潰瘍性大腸炎様所見を呈し非乾酪性類上皮細胞肉芽腫を認め，6年間経過を追えた1例

Crohn's Disease and Ulcerative Colitis were Observed Synchronously, and Followed up for Six Years, Report of a Case

要旨　患者は23歳，男性．17歳時，水様下痢・下血が出現し，大腸内視鏡検査（CF）で白点を伴う浮腫状の軽度発赤粘膜を直腸から盲腸までびまん性に認めた．潰瘍性大腸炎（UC），全大腸炎型と診断し，salazosulfapyridine（SASP），ステロイド投与にて緩解した．4年後に再燃し，その後はステロイド減量に伴い再燃を繰り返した．再燃後のCFでは，直腸からS状結腸に小びらんの多発を伴う連続性びまん性の発赤粗ぞう粘膜を認めたが，下行結腸から盲腸には病変を認めず，直腸・S状結腸炎型でUCが再燃したものと考えられた．しかし，回盲弁から終末回腸にかけて，小不整形潰瘍を伴い約2cmが狭窄し，更に健常粘膜を介して狭窄部より約10cm口側に3/4周性の不整形潰瘍を認めた．組織所見では，直腸からS状結腸はUC，終末回腸はCrohn病（CD）に合致するものであった．内視鏡的，病理学的に両疾患の合併も疑われる興味深い症例と考え報告した．

　A 17-year-old male was admitted to the hospital because of watery diarrhea and hematochezia. The first colonoscopy revealed diffusely edematous and fragile mucosa all over the colorectum and a diagnosis of ulcerative colitis was made. Retrospectively, it was noticed that the biopsy specimen from the ascending colon contained a non-caseating epithelioid cell granuloma. Four years later, the patient relapsed presenting proctosigmoiditis, with stricture of the ileo-cecal valve and skipped ileal deep ulcer. Histological findings of biopsy specimens taken from the rectum and sigmoid colon were compatible with ulcerative colitis, and those from the terminal ileum and ascending colon showed granulomas, which were compatible with Crohn's disease.

　So, we suggest this patient might have both Crohn's disease and ulcerative colitis concomitantly.