A Case of Crohn's Disease with Only Aphthoid Lesions inwhom Non-Caseous Granuloma was Revealed before the Appearance of Aphthoid Lesions.

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A 21-years old female patient with Crohn's colitis in whom abnormal findings were colonic aphthoid lesions alone, was presented. She came to the hospital on May 1993 because of iron deficiency anemia, and the fecal occult blood was positive. Barium enema study revealed a polypoid lesion about 3 cm in diameter in the sigmoid colon. The polyp was resected endoscopically and was diagnosed as juvenile polyp histologically. Although colonic mucosa except polypoid lesion seemed to be normal, non-caseous granuloma was demonstrated in the submucosa of polypectomied specimen retrospectively. Six months later, 2nd colonoscopy was performed because of abdominal pain and bloody stool. It showed multiple aphthoid erosions of 1-3 mm in diameter surrounded with red halo through entire colon and they were arranged longitudinal in the terminal ileum. Biopsy specimen revealed non-caseous granuloma with cellular infiltration. Crohn's disease was diagnosed and symptoms was improved after administration of sulfasarazopyridine (3g/day). On October 14th 1994, colonofiberscopy showed no aphthoid erosions in the rectum but multiple tiny elevated lesions which showed lymphoid follicular formation histologically. But aphthoid lesions in the terminal ileum remained unchanged. This is the first report of Crohn's colitis which demonstrates non-caseous granuloma before the appearance of the aphthoid lesions.
社団法人日本消化器内視鏡学会の論文