大腸病変を随伴したサルコイドーシスの1例

Sarcoidosis with Involvement at the Large Intestine, Report of a Case

要旨　大腸病変を随伴したサルコイドーシスのまれな1症例について報告した．患者は29歳男性，1980年1月ぶどう膜炎による眼症状で発症し，胸部X線写真で両側肺門リンパ節腫脹と左中肺野に粒状影が認められサルコイドーシスと診断した．ステロイド治療で胸部および眼病変は治癒し，両病変が緩解状態の1984年2月から排便時新鮮出血が起こり，大腸内視鏡およびX線検査を施行した．直腸下部に結節状の隆起を伴う不整形の潰瘍性病変があり，正常粘膜を挾んで下行結腸に表層性の粘膜病変が認められた．直腸生検で類上皮細胞肉芽腫が見出され，全身性サルコイドーシスの大腸病変と診断した．ステロイドの経口坐薬併用治療により下血は消失し，内視鏡的にも著明な改善が認められた．

　The patient, 29 year-old man, noted its onset through symptomes in the eyes caused by uveitis in January 1980. X-ray picture of the chest showed swelling of the bilateral hilar lymph nodes and granular shadow at the left middle lung field which led us to diagnose it as sarcoidosis. Lesions of the chest and the eyes were healed by steroid herapy. However, starting February 1984 when both lesions were in remission, anal fresh bleeding occurred at defecation. Thus, colonoscopy and barium enema were conducted and disclosed irregularly-shaped ulcerative lesions with nodular elevation in the lower rectum, and superficial mucosal lesions between normal mucosa in the descending colon. Histology of biopsy specimen taken from the rectal lesion showed epithelial cell granuloma which made us diagnose it as systemic sarcoidosis at the large intestine. After steroid therapy, melena disappeared and endoscopy showed marked improvement of the lesions.