潰瘍性大腸炎に合併した増殖性化膿性口内炎の1症例

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A case of pyostomatitis vegetans associated with ulcerative colitis of a 22-year old woman has been reported, and clinical appearances, etiology and immunological mechanisms of development were discussed. Ulcerative colitis, as well as Crolms disease and proctitis, is one of the inflammatory bowel diseases which have many local and systemic complications. Oral manifestations of ulcerative colitis arc as follows; 1) recurrent aphthous ulceration, 2) pyostomatitis vegetans, 3) ulcers analogous to pyoderma gangrenosum of the skin and 4) hemorrhagic ulcers of the oral mucosa and skin.<BR>The present case showed clinical appearances of above pyostomatitis vegetans, indicating numerous small papillary projections that contained miliary abscesses occurring in an area of intense erythema on the gingiva. The mucosa had been thrown into folds along gingivobuccal sulucus. Bacteriologic studies revealed no specific findings except normal oral microorganisms. Little subjective discomfort was associated with this condition. The histopathologic appearances were also compatible with pyostomatitis vegetans in which acanthosis and hyperkeratosis could be seen with elongation of the rete pegs. Small pustules existed in and under the epithelium of papillary projections. A dense lymphocytic and plasms cellular infiltration was found in the lamina propria, and cellular infiltration was reconfirmed by direct immunofluorescence technique using antihuman IgA antibodies, etc.<BR>The oral manifestation became worse and regressed according to the conditions of recurrence and covalescence of ulcerative colitis. The lesion responded well to topical application of a gluco-corticoid steroid hormone.<BR>The present case indicates that, in findings this kind of lesion on the oral mucosa, a possibility of gastrointestinal disturbance due to inflammatory bowel disease should be considered.

潰瘍性大腸炎に合併した増殖性化膿性口内炎の1症例

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