消化管病変としてアフタ様潰瘍のみを認めたCrohn病の1例

Multiple Aphthoid Ulcers of Gastrointestinal Tract-A case report of Crohn's disease

要旨　患者は29歳男性．下痢，腹痛，体重減少を主訴として入院した．入院時，白血球増多，CRP陽性，血沈元進などの炎症所見を認めた．検便では潜血陽性で，虫卵，原虫は認めず，便培養では有意な菌は検出されなかった．消化管X線検査，内視鏡検査では胃前庭部から大腸まで広範囲に散在するアフタ様潰瘍を認めた．S状結腸および胃前庭部からの生検で非乾酪性類上皮細胞性肉芽腫が認められ，Crohn病と診断した．経管成分栄養にて臨床所見と腸管病変の改善を認めていたが，1年後には腸管病変の再発，痔痩の出現を認め現在治療中である．本例は通常みられるCrohn病の肉眼形態とは異なり，アフタ様潰瘍のみを消化管病変としていた点で非定型的であった．

　A 29 year-old man visited our hospital complaning of diarrhea, abdominal pain and body weight loss. Laboratory examination revealed leucocytosis, positive C-reactive protein, and elevated erythrocyte sedimen-tation rate. On gastrointestinal roentgenographies and endoscopic examinations, multiple aphthoid ulcers were found in the prepyloric region of the stomach, duodenum, small intestine and colon. Histological examination of the biopsy specimens from the sigmoid colon and stomach showed non-caseating epithelioid cell granulomas with Langhans giant cells, suggesting Crohn's disease. The patient was treated primarily with elemental diet alimentation for one month, and this resulted in a remission of symptoms and a resolution or healing of aphthoid ulcers. One year later, he underwent fistulectomy for painful peri-anal fistulas. On the follow-up gastrointestinal roentgenographies and endoscopic examinations, multiple aphthoid ulcers were found again in the duodenum and small intestine. This case was considered to be an unusual type of Crohn's disease, because the only gastrointestinal lesions recognized were aphthoid ulcers.