胃と腸58巻6号

2023年06月発行

今月の主題 分類不能腸炎（IBDU）の現状と将来展望 主題症例

Crohn病・潰瘍性大腸炎両疾患の内視鏡所見が異時性にみられたIBDUの1例

著者： 川崎啓祐¹ 梅野淳嗣¹ 川床慎一郎¹² 平野敦士¹ 谷口義章¹² 加来寿光³ 岡本康治³ 柿添梢¹ 長末智寛¹ 松野雄一¹ 冬野雄太¹ 藤岡審¹ 森山智彦¹⁴ 檜沢一興³ 鳥巣剛弘¹

所属機関： ¹九州大学大学院医学研究院病態機能内科学 ²九州大学大学院医学研究院形態機能病理学 ³九州中央病院消化器内科 ⁴九州大学病院国際医療部

ページ範囲：P.795 - P.802

要旨●患者は10歳代，男性．主訴は腹痛，下痢．大腸内視鏡検査で上行結腸から下行結腸にかけて粘膜浮腫と縦走潰瘍を，S状結腸には小潰瘍から不整形潰瘍を認めた．Crohn病と診断しインフリキシマブを導入し，アザチオプリンの投与を行うものの寛解維持が困難であり，経過観察の大腸内視鏡検査では終末回腸はやや粗糙で，また直腸から連続性に全大腸に粗糙粘膜，びらん，血管透見像の消失を認めた．回腸からの生検では非乾酪性類上皮細胞肉芽腫を，大腸からの生検では炎症細胞浸潤，陰窩炎，陰窩膿瘍および杯細胞の減少を認めた．異時性にCrohn病，潰瘍性大腸炎両者の内視鏡所見を，同時性に両者の病理組織像を認めたことから，IBDUと診断した．青黛の内服投与で寛解導入され，3年後の大腸内視鏡検査では粘膜治癒が確認された．

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