A Case of Inflammatory Bowel Disease with Large Colonic Ulcers and Punched-Out Esophageal Ulcers in which Making the Definite Diagnosis was Difficult

Abstract

A 21-year-old female entered our hospital complaining of diarrhea, abdominal pain and body weight loss. Colonoscopic examination revealed multiple small and middle sized discrete ulcers throughout the whole colon and two large and deep ulcers in the ascending colon. Biopsy specimens taken from the small ulcers of the left sided colon showed non-caseating epithelioid cell granuloma histologically. And upper gastrointesinal endoscopic examination revealed multiple punched-out ulcers in the middle and lower segments of the esophagus. Granuloma was not evident in biopsy specimens taken from the esophageal ulcers. Though the large colonic ulcers and punched-out esophageal ulcers suggested Behçet's disease or simple ulcer, we suspected her illness as Crohn's disease due to detection of granuloma and prescribed her Prednisolone. Then, she recovered and follow-up endoscopic examination showed improvement of the ulcers. This case was difficult to make definite diagnosis.