A 19-year-old man was admitted to our hospital complaining of watery diarrhea and body weight loss. Laboratory examinations showed positive CRP and mild elevated erythrocyte sedimentation rate. Stool culture disclosed no pathogenic bacterium.
Initial barium enema showed numerous aphthoid lesions throughout the entire colon and rectum. Colonoscopy revealed aphthoid ulcers on the mucosal surface from the rectum to the descending colon. Histological examination of the biopsy specimen from rectum showed non-caseating epithelioid cell granuloma. Anal fissures were found in the rectal examination. We diagnosed the patient as suffering from Crohn's disease.
Remission was obtained by the administration of salazosulfapyridine and his clinical course was uneventful. But 2 years later, his symptoms got worse and follow-up colonoscopic examination revealed longitudinal ulcerations on the descending and the transverse colon. By treatment with elemental diet alimentation, the patient has been given relief. This case was considered important in speculating the natural course of Crohn's disease.