An Unusual Form of Aphthoid Proctocolitis

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Abstract
An unusual form of aphthoid colitis is presented. A 21 ‐year‐old man complained of hematochezia for about 2 years. Examinations revealed crowded polypoid lesions in the lower rectum: the closer to the anus the site was, the bigger the size of the polypoid lesions. Polypoid lesions were also observed in the terminal ileum and on the ileocecal valve. Biopsy specimens revealed that these polypoid lesions were lymph follicles. Lymphoid hyperplasia was observed in the upper rectum and proximal colon but not in the transverse colon. The patient was given a salicylazosulfapyridine suppository followed by a rapid ceasing of hematochezia on the following day and disappearance of most lymph noduli in the rectum by the second week. About two years later hematochezia recurred. The findings of the lower rectum and the response to the suppository were the same as in the first episode. Known diseases associated with aphthoid colitis were ruled out.The present case is unusual in several respects compared to typical apthoid colitis: the clinical course is not acute self‐limited but chronic protracted; the lesions are distributed not evenly in the large bowel or its segment(s) but in the lower rectum, in addition, the lesions become more pronounced toward the anus; skipped lymph noduli are observed in the ileocecal valve and the terminal ileum. The other characteristics of this case include a marked response to salicylazosulfapyridine, recurrence, no precedence of flu‐like syndromes, no symptoms except for hematochezia, and normal laboratory data.

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