Abstract
The patient is a 21-year-old male, who complained of watery diarrhea, lower abdominal pain and fever. Barium enema and colonoscopy revealed ulcers and inflammatory polyps scattered from the sigmoid colon to the transverse colon, so that ulcerative colitis was suspected. He was treated with salazopyrin and steroid, however, there was no improvement. Then medication was changed to anti-tuberculous therapy. The effect was dramatic. His symptoms and sings were relieved within a month. He had bilateral hearing loss due to toxic reaction by streptomycin (SM) two months later. Once SM was stopped, the recurrence occurred. Total colectomy was performed. On the resected specimen, longitudinal ulcers, cobble stone appearance and thickness of wall were seen with several small erosions. Histological study disclosed that transmural inflammatory spreads across all layers of the transverse colon. There were small granulomas without caseation in the submucosal layer. Regional mesentric lymph nodes also revealed similar with infiltration of a few Langhans' giant cells. According to the diagnotic criteria of Crohn's disease propsed by the Japanese Society of Gastroenterology, it is difficult to rule out Crohn's disease, however, the dramatic effect of SM-indicates the possibiliby of the rapentic diagnosis of tuber culosis. Discussion was made shortly in diagnosis and treatment of this rare and tnter-esting case.
