CROHNS-DISEASE ASSOCIATED WITH PELLAGRA AND INCREASED EXCRETION OF 5-HYDROXYINDOLACETIC ACID

A 47-year-old woman with seronegative polyarthritis, diarrhea, and pho tosensitivity dermatitis was found to have Crohn's disease and pellagr a. The presence of high values of 5-hydroxyindolacetic acid in the uri ne began the exhaustive investigations and finally enterotomy. No mass lesion was found. Argyrophilic cells were not increased in areas of i nflamed intestinal mucosa or the normal mucosa. The disagreement betwe en biochemical and histologic findings was attributed to sampling erro r. Antiinflammatory treatment for Crohn's disease was given and the ga strointestinal and articular symptoms improved, excretion of 5-hydroxy indolacetic acid returned to normal and there was no relapse of pellag ra. Pellagra as a complication of Crohn's disease has been described i n 4 cases; malnutrition and intestinal malabsorption were the proposed mechanisms for the niacin deficiency and pellagra of those patients. In the current case, the pathogenesis of pellagra may be accounted to wastage of tryptophan by an increased pool of intestinal argyrophilic cells, suggested by increased urinary excretion of 5-hydroxyindolaceti c acid.