APHTHOID ULCERS WITH LATE-DEVELOPING OF LONGITUDINAL ULCERS IN CROHN'S DISEASE : REPORT OF TWO CASES

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We reported two patients with Crohn's disease initially having only aphthoid ulcers who developed longitudinal ulcers during the long-term clinical course. The first case was a 29-year-old man who was admitted to our hospital complaining of diarrhea, abdominal pain, and weight loss. Initial radiography and endoscopy revealed widespread aphthoid ulcers in the stomach, duodenum, small intestine, and colon. Histologic examination of the biopsy specimens showed non-caseating epithelioid cell granulomas, and therefore suggested to be Crohn's disease. Two years and 6 months later, radiography revealed longitudinal ulcer in the sigmoid colon. The second case was a 20-year-old woman who was admitted to our hospital complaining of diarrhea and abdominal pain. Initial examinations including X-ray and endoscopy revealed multiple aphthoid ulcers in the stomach, duodenum, small intestine, and colon. Stool culture was negative. Histologic examination of the biopsy specimens showed no specific findings, but clinical features indicated Crohn's disease rather than other inflammatory bowel diseases. Two years and 8 months later, repeated radiography revealed longitudinal ulcer in the ileum. These findings suggested that aphthoid ulcer seemed to be the earliest lesion of Crohn's disease.
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