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NEJM：克罗恩病或导致口面部炎症！

2015-06-04 MedSci MedSci原创

瘘道克罗恩病手术治疗
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一名28岁的青年男子在6年前被诊断患有克罗恩病，尽管在随后的治疗过程中有使用免疫抑制剂和生物疗法进行治疗，但在2年前还是出现了口面部肉芽肿炎症的现象（图A与B所示）。而此前他曾因肠瘘疾病行过外科回肠造口术。通过磁共振成像与造影剂显影显示口面部的病灶是由于口腔黏膜发炎导致出现了orocutaneous瘘管（如图C所示）。在牙齿和窦道内刮取组织检测显示为肉芽肿性炎症，但未见有感染性的物质。经明确诊断，

一名28岁的青年男子在6年前被诊断患有克罗恩病，尽管在随后的治疗过程中有使用免疫抑制剂和生物疗法进行治疗，但在2年前还是出现了口面部肉芽肿炎症的现象（图A与B所示）。而此前他曾因肠瘘疾病行过外科回肠造口术。


通过磁共振成像与造影剂显影显示口面部的病灶是由于口腔黏膜发炎导致出现了orocutaneous瘘管（如图C所示）。在牙齿和窦道内刮取组织检测显示为肉芽肿性炎症，但未见有感染性的物质。

经明确诊断，该男子上述的症状是由克罗恩病导致的。克罗恩病最明显的特征是慢性肠道肉芽肿性炎症，它可以在口腔到肛门之间的任意一个肠道部位发生病变。但在本案例中，肉芽肿炎症发生在口面部却是非常罕见的。随后，为了解决该男子现存的问题，主治医生采取拔除牙齿再予抗生素治疗，成功地解决了瘘道的问题。

在随后的1年跟踪访问中，发现其口面部的疾病并无复发的迹象，并已成功地完成了直肠切除手术。目前，他继续以阿达木单抗和甲氨蝶呤治疗基础疾病。

原始出处：

Rishi Mahendra Goel, M.B., B.S., and Esther Hullah, M.B., B.S. Orofacial Fistulae Associated with Crohn’s Disease. N Engl J Med 2015; 372:e29May 28, 2015DOI: 10.1056/NEJMicm1402919 

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    2016-08-20 doctorJiangchao

    继续关注

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=101802, encodeId=c291101802c3, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 21:25:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101801, encodeId=e06410180151, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 21:24:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28344, encodeId=6db02834437, content=厉害！, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ed101627734, createdName=Messichen1992, createdTime=Sun Jun 21 08:54:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26514, encodeId=d9152651432, content=晕，天天长痘痘呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Tue Jun 09 14:09:00 CST 2015, time=2015-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26024, encodeId=7e662602439, content=精彩病例, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Fri Jun 05 00:04:00 CST 2015, time=2015-06-05, status=1, ipAttribution=)]
    2016-08-20 doctorJiangchao

    继续学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=101802, encodeId=c291101802c3, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 21:25:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101801, encodeId=e06410180151, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 21:24:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28344, encodeId=6db02834437, content=厉害！, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ed101627734, createdName=Messichen1992, createdTime=Sun Jun 21 08:54:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26514, encodeId=d9152651432, content=晕，天天长痘痘呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Tue Jun 09 14:09:00 CST 2015, time=2015-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26024, encodeId=7e662602439, content=精彩病例, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Fri Jun 05 00:04:00 CST 2015, time=2015-06-05, status=1, ipAttribution=)]
    2015-06-21 Messichen1992

    厉害！

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=101802, encodeId=c291101802c3, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 21:25:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101801, encodeId=e06410180151, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 21:24:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28344, encodeId=6db02834437, content=厉害！, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ed101627734, createdName=Messichen1992, createdTime=Sun Jun 21 08:54:00 CST 2015, time=2015-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26514, encodeId=d9152651432, content=晕，天天长痘痘呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Tue Jun 09 14:09:00 CST 2015, time=2015-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26024, encodeId=7e662602439, content=精彩病例, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Fri Jun 05 00:04:00 CST 2015, time=2015-06-05, status=1, ipAttribution=)]
    2015-06-09 惜言

    晕，天天长痘痘呢

    0

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    2015-06-05 medcardio

    精彩病例

    0

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