口腔，陰部潰瘍および特異な潰瘍配列を示した小腸・大腸Crohn病と考えられる1例

An Unusual Case of Crohn's Disease Manifesting Oral and Genital Ulcers, and a Specific Pattern of Linear Ulcer Formation from the Ileum to the Rectum

要旨　患者は20歳男性で下痢，口腔内潰瘍，陰部潰瘍のため入院した．下痢は3か月，ほかは1か月持続した．入院時X線，内視鏡検査では回腸から直腸まで，びまん性に多数の小潰瘍があり，左側結腸では周堤を伴う不整形の浅い潰瘍を認めた．また，部分的には潰瘍が縦配列を示し，縦走潰瘍像を呈した．入院後，100日間prednisolone，salazosulfapyridineなどによる保存的治療を続けたが，大量下血が改善しないため，大腸亜全摘を施行した．病理組織学的検査では，潰瘍はUl-Ⅱの浅い潰瘍で炎症の主体は粘膜内に限局しているが，潰瘍底部にあたる部分では炎症細胞浸潤は漿膜にまで達していた．以上の所見より縦走潰瘍，全層性炎症，更にアフタ性潰瘍を初期病変とした小腸・大腸Crohn病と考えた．自験例のごとき縦走潰瘍の初期と思われる所見は今後Crohn病を検討するのに際して興味ある事象と考えた．

　It is difficult to distinguish each other among nonspecific inflammatory bowel diseases. We have experienced a case of Crohn's enterocolitis accompanied with a large ulcer on the oral palate and multiple ulcers of the penis, which showed a unique course resembling other inflammatory bowel diseases. A 20 year-old man was admitted to the hospital complaining of diarrhea, oral and penile ulcers. He had been suffering from diarrhea and ulcer symptom for three and one month respectively.

　Radiographic and endoscopic studies on admission showed multiple small ulcers diffusely scattered from the ileum to the rectum. They showed partially a linear pattern and ulcers were irregular in shape with a round wall in the sigmoid colon. The patient developed massive bleeding, and subtotal colectomy was subsequently carried out.

　On the resected specimen, shallow ulcers were noted throughout the entire colon and inflammatory changes were seen mainly in the mucosa, but inflammatory cells infiltrated the serosa at the base of the ulcer. We were unable to verify granulomas in this specimen.

　Judging from those findings mentioned above, this case may be classified as an unusual Crohn's enterocolitis. The characteristics in our case is to show an early figure of longitudinal ulcer in Crohn's disease and has an unusual complications such as oral and genital ulcers.