Kono Mizuki, Oshitani Nobuhide, Sawa Yoshinori, Watanabe Kenji, Kamata Noriko, Oiso Ryuta, Inagawa Makoto, Kawachiya Tomohiro, Kawashima Daichi, Sogawa Mitsue, Jinno Yoshio, Watanabe Kenji, Higuchi Kazuhide, Matsumoto Takayuki, Arakawa Tetsuo
Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
J Gastroenterol. 2003;38(9):891-5. doi: 10.1007/s00535-002-1167-3.
A 31-year-old man with Crohn's disease developed arthritis, spiking fever, and skin rash indistinguishable from that of adult-onset Still's disease. He was admitted to our hospital because of a periumbilical intestinal skin fistula. Crohn's disease had been diagnosed in 1991, and had required intestinal resection twice, and schizophrenia had been diagnosed in 1993. He developed polyarthritis and spiking fever, accompanied by a macular skin rash on both forearms. Marked hepatosplenomegaly and bilateral pleural effusion were detected on computed tomography examination. These findings are indistinguishable from those of adult-onset Still's disease. Because his mental status had deteriorated following high-dose prednisolone on a previous admission, he was treated with an immunosuppressive agent on this occasion, with the treatment being successful. This is the first report of adult-onset Still's disease complicating Crohn's disease. In patients with Crohn's disease, polyarthritis and skin rash can easily be misdiagnosed as enteropathic arthritis with erythema nodosum associated with the Crohn's disease. Although adult-onset Still's disease may not be fatal, early diagnosis is important because it can, in rare cases, result in life-threatening complications.
一名31岁的克罗恩病男性患者出现了关节炎、高热和皮疹，与成人斯蒂尔病难以区分。他因脐周肠皮肤瘘入住我院。1991年诊断为克罗恩病，曾接受过两次肠道切除术，1993年诊断为精神分裂症。他出现了多关节炎和高热，伴有双侧前臂的斑丘疹。计算机断层扫描检查发现明显的肝脾肿大和双侧胸腔积液。这些表现与成人斯蒂尔病难以区分。由于他在之前住院时接受大剂量泼尼松龙治疗后精神状态恶化，此次给予免疫抑制剂治疗，治疗成功。这是成人斯蒂尔病合并克罗恩病的首例报告。在克罗恩病患者中，多关节炎和皮疹很容易被误诊为与克罗恩病相关的伴有结节性红斑的肠病性关节炎。虽然成人斯蒂尔病可能不会致命，但早期诊断很重要，因为在罕见情况下它可能导致危及生命的并发症。
