Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Simple Ulcer of the Terminal Ileum Successfully Treated by Monoclonal Antibody to Tumor Necrosis Factor-${\alpha}$ (Infliximab)

Tumor Necrosis Factor-${\alpha}$ Monoclonal Antibody (Infliximab)으로 치료한 회장 말단부의 단순 궤양

  • Lee, Seok-Jong (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Chung, Woo-Chul (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Kang-Moon (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Oh, You-Suk (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Eun-Jung (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Choi, Kang-Hyun (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Paik, Chang-Nyol (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 이석종 (가톨릭대학교 의과대학 내과학교실) ;
  • 정우철 (가톨릭대학교 의과대학 내과학교실) ;
  • 이강문 (가톨릭대학교 의과대학 내과학교실) ;
  • 오유석 (가톨릭대학교 의과대학 내과학교실) ;
  • 김은정 (가톨릭대학교 의과대학 내과학교실) ;
  • 최강현 (가톨릭대학교 의과대학 내과학교실) ;
  • 백창렬 (가톨릭대학교 의과대학 내과학교실)
  • Received : 2010.02.15
  • Accepted : 2010.05.18
  • Published : 2010.07.30
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Abstract

Nonspecific and idiopathic ulcer of the small bowel or colon is a rare condition, and it is the so called "simple ulcer" when the patients do not have systemic symptoms of Behcet's syndrome. Differentiation of simple ulcer from intestinal Behcet's disease according to the endoscopic and pathologic findings is often impossible and the clinical course of the 2 maladies is similar. A 51-year-old man presented with low abdominal pain, and colonoscopy revealed a huge deep ulceration with an entero-enteric fistula in the terminal ileum. He was diagnosed with simple ulcer without the constitutional symptoms of Behcet's syndrome. He was refractory to conventional therapy with corticosteroids and antibiotics, and so he required surgical resection. Monoclonal antibody against tumor necrosis factor-${\alpha}$ (Infliximab) was administered at 0, 2 and 6 weeks. His symptoms were relieved after the therapy and the ulceration had completely resolved after 1 year. He was entirely asymptomatic at the 36 month follow up.

소장이나 대장에서 발생하는 비특이적 궤양은 드물게 발생한다. 내시경이나 병리 소견으로 베체트 장염과 구분하기 어려울 뿐 아니라 임상 경과도 매우 유사하다. 따라서 베체트병의 다른 전신 증상이 없는 경우를 단순 궤양(simple ulcer)이라고 부른다. 이번 증례는 지속적인 우하복부 통증을 호소한 51세 남자 환자에서 대장내시경검사를 실시하였고, 회장 말단부에 크고 깊은 궤양 병변과 함께 소장 누공이 관찰되었다. 베체트 장염과 유사하였지만, 전신 증상이 없어 단순 궤양으로 진단하고, 스테로이드와 항생제 요법을 실시하였으나 임상 경과의 호전이 없었다. TNF-${\alpha}$ 단클론항체인 infliximab을 사용하여 증상의 호전을 보였고 내시경에서 완전 치유 소견을 보였다. 이후 36개월 동안 재발 없이 관찰하고 있어 문헌 고찰과 함께 보고한다.

Keywords

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