アフタ様病変のみで発症したCrohn病の1例

Crohn's Disease Developing from Aphthoid Lesions, Report of a Case

要旨　患者は23歳，男性．発熱，下痢，腹痛を主訴に入院した．入院時，CRP高値，血沈亢進などの炎症所見を認めた．便培養では有意な細菌は検出されなかった．大腸内視鏡検査で横行結腸に縦列するタコイボ様のアフタ様病変を認めた．この部位の生検で非乾酪性類上皮肉芽腫を認めたので，臨床所見と併せてCrohn病と診断した．約1か月でアフタ様病変とは別の部位に縦走潰瘍やcobblestone appearanceを認める典型例に進行した．当初認めたアフタ様病変は治癒していた．IVHとし，prednisoloneとsulfasalazineの投与で緩解を得，その後現在まで緩解状態を維持している．アフタ様病変は本例では必ずしも進行しなかったことから，単なるCrohn病の初期病変でないことを示唆している．

　A 23-year-old man was admitted to our hospital complaining of a high fever, diarrhea and abdominal pain. The laboratory data of inflammation, such as a high CRP, and elevated erythrocyte sedimentation rate were shown. Stool culture revealed no pathogenic bacterium. On colonoscopic examination, verrucous aphthoid lesions arranged lengthwise were shown in the transverse colon. The biopsy specimens of the aphthoid lesions showed non-caseating epithelioid granuloma, diagnosed as Crohn's disease. After a month, longitudinal ulcers and cobblestone appearance were shown in a region different from that of the aphthoid lesions. The aphthoid lesions were cured. By treatment with TPN, and administration of prednisolone and sulfasalazine, the patient has been given relief. Aphthoid lesions are not directly considered as the initial stage of Crohn's disease, and this case suggests that they do not always develop into longitudinal ulcersor cobblestone apperance.