アフタ様病変の状態で8年間経過観察中のCrohn病の1例

Crohn's Disease Showing Only Aphthoid Lesions of the Colon was Stationary for Eight Years, Report of a Case

要旨　患者は26歳，女性．下痢，下血および左下腹部痛を主訴に来院．内視鏡検査で右側結腸粘膜に発赤，浮腫およびアフタ様病変を認めた．自覚症状は2，3日で消失し臨床検査所見上も異常を認めなかったため，1年半後の生検組織像に肉芽腫がみられたが，初診から3年間無治療で経過観察された．3年後，軽度の炎症所見と，内視鏡検査でアフタ様病変のわずかな増加を認めた．以後salazosulfapyridine(SASP)のみで治療し，5年間寛解を維持し現在も経過観察中である．

　A 26-year-old woman visited our hospital because of diarrhea, hematochezia and lower abdominal pain. Although the colonofiberscopic examination showed aphthoid lesions in diffuse reddish and edematous mucoca in the right-sided colon, the symptoms disappeared immediately with antilaxatives, and the result of physical and laboratory examination was negative. The second histological examination a year and a half later revealed epithelioid cell granulomas, and the diagnosis of Crohn's disease was made. Three years after the first examiration, the laboratory findings showed that the patient's condition had slightly worsened and the number of aphthoid lesions found endoscopically had increased. SASP was prescribed, and the patient has been well for five years, relying only on SASP.

　This case indicated that aphthoid lesions do not necessarily get worse and change to longitudinal ulcers or to the cobblestone appearance.