A Case of Crohn's Disease Diagnosed from a Subcutaneous Abscess Caused by Enterocutaneous Fistula

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  • 結腸皮膚瘻による皮下膿瘍を契機に診断された Crohn 病の 1 例
  • 症例 結腸皮膚痩による皮下膿症を契機に診断されたCrohn病の1例
  • ショウレイ ケッチョウ ヒフソウ ニ ヨル ヒカ ノウショウ オ ケイキ ニ シンダン サレタ Crohnビョウ ノ 1レイ

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A 26-year-old Japanese female presented with a two-week history of a gradually growing erythematous swelling on her left lumbar region, 10 cm in diameter with pain and oozing pus. Physical examination showed no fever and no abdominal signs. Contrast-enhanced computed tomography and magnetic resonance imaging revealed that the subcutaneous swelling was connected with an enterocutaneous fistula. Bacterial cultivation identified Escherichia coli and Streptococcus anginosus from the pus. We performed drainage together with administration of antibiotics immediately. A barium enema showed stenosis of the descending colon and enterocutaneous fistula. Colonoscopy showed a cobblestone appearance of the colonic mucosae as well as colonic stenosis. She was diagnosed with an enterocutaneous fistula associated with Crohn's disease, and was treated with anti-TNF-α therapy. Although subcutaneous abscess is common, enterocutaneous fistula caused by Crohn's disease is uncommon. Physicians should consider the possibility of enterocutaneous fistula in cases presenting with a subcutaneous abscess on the trunk.

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