MONOZYGOTIC TWINS WITH CROHNS-DISEASE AND ULCERATIVE-COLITIS - A UNIQUE CASE-REPORT

Background-A large number of monozygotic and dizygotic twin pairs with inflammatory bowel disease have been reported. To date no twin pair h as developed phenotypically discordant inflammatory bowel disease. Thi s case report is the first documented occurrence of discordant inflamm atory bowel disease occurring in monozygotic twins. Case report-Twenty two year old identical male twins presented within three months of ea ch other with inflammatory bowel disease that proved to be discordant in overall disease type, disease distribution, clinical course, and hi stopathological findings. Twin 1 developed a severe pancolitis necessi tating total colectomy while twin 2 developed a predominantly distal p atchy colitis with frequent granulomas, controlled by aminosalicylates . Twin 1 was antineutrophil cytoplasmic antibody (ANCA) negative at th e time of testing while twin 2 (Crohn's disease) was ANCA positive. Si gnificantly, the twins possessed the HLA type DR3-DR52-DQ2 previously associated with extensive colitis. Conclusion-This case report confirm s the important role played by genetic factors in the development of i nflammatory bowel disease. It also highlights the crucial role of unde termined environmental agents in dictating disease expression and phen otype.