咽頭病変の診断に苦慮した腸管ベーチェット病の1例

A case of entero-Behcet's disease with confusing pharyngeal lesions

Ⅰ　はじめに

　ベーチェット病は口腔咽頭などの消化管粘膜病変，眼病変，皮膚病変などの多彩な症状をきたす原因不明の炎症性疾患であり，しばしば診断や治療に難渋する。

　今回われわれは，反復性扁桃炎として両側口蓋扁桃摘出術を受けたが，術後も継続する咽頭病変と発熱を主訴に来院した症例で，その後の精査にて腸管ベーチェット病の診断に至った症例を経験したので，若干の文献的考察を加えて報告する。

　Behcet's disease is a chronic inflammatory disease with unknown cause that shows oral,pharyngeal,ocular,skin and genital lesions. A 49-year-old woman suffered from fever up and pharyngeal pain. Under a diagnosis of recurrent tonsillitis,she underwent tonsillectomy in a previous hospital,but the symptoms did not improve. When she was first seen by us,she presented a whitish bulge in the tonsillar fossa with multiple whitish lesions in the hypopharynx and larynx. Biopsy specimen from the tonsillar fossa showed necrotic tissue with the infiltration of inflammatory cells. Administration of an antibiotic was ineffective. Fiberscopy of the lower digestive tract revealed punched-out ulcers of the ileocecal region,leading to the diagnosis of entero-Behcet's disease. The patient received anti-TNF-α therapy,and complete remission was achieved. We stress that systemic examinations are needed to manage patients with recurrent and intractable pharyngeal lesions.