アフタ様大腸炎から典型像への進展を観察しえた全大腸炎型潰瘍性大腸炎の1例

Aphthoid Colitis as a Preceding Lesion of Ulcerative Colitis, Report of a Case

要旨　患者は65歳，男性．発作性夜間血色素尿症のため当院通院中，便潜血反応陽性を指摘された．大腸内視鏡検査および注腸X線検査で上行結腸から下行結腸にかけて多発するアフタ様病変を認めた．経過観察中アフタ様病変の分布が直腸へと拡大し，続いて下行結腸からS状結腸は区域性・連続性にびらんを伴う顆粒状粘膜へと変化した．更に初回検査から7か月後には典型的な全大腸炎型潰瘍性大腸炎に進展し，ステロイド剤とサルファ剤が奏効した．本例では潰瘍性大腸炎の初期像や進展過程を知るうえで示唆に富む画像の推移が観察可能であった．

　A 65-year-old man with a previous diagnosis of paroxysmal nocturnal hemoglobinuria was referred to our division, because of positive fecal occult blood. Colonoscopy showed multiple aphthoid lesions, which were predominantly located from the ascending colon through descending colon. These lesions subsequently extended to the rectum and, thereafter, developed in rough-surfaced mucosa and multiple erosions of a segment in the descending and sigmoid colon. Seven months later, colonoscopy and barium enema examination revealed that the aphthoid colitis had progressed to typical ulcerative colitis of entire type. This case seems to be suggestive of the initial lesions and their pregression to ulcerative colitis, which have been still poorly investigated to date.