B. Gallwitz et al., DIFFERENTIAL-DIAGNOSIS OF GRANULOMATOUS D ISEASES - INTESTINAL AND HEPATIC NONCASEATING GRANULOMAS IN CROHNS-DISEASE, Zeitschrift fur Gastroenterologie, 32(5), 1994, pp. 252-255
Extraintestinal manifestations of Crohn's disease include a number of
inflammatory diseases. The clinical activity of these associated disea
ses may in some cases parallel that of the intestinal inflammation. Th
e activity of extraintestinal manifestations may however be paramount.
A cause and effect relationship has not been shown for extraintestina
l manifestations such as eye involvement, arthritis and accompanying h
epatitis. The histological changes of extraintestinal manifestations c
onsists of noncaseating granulomas that are difficult to distinguish f
rom granulomas occurring in other systemic inflammatory diseases. This
report is on a female patient with lower abdominal pein, fatigue, nig
ht-sweat, weight loss, episkleritis and diarrhea without blood and sli
me. Noncaseating granulomas were found in the colon and liver, but not
in the lung. The differential diagnosis between the extrapulmonary ma
nifestation of sarcoidosis and a generalized Crohn's disease is discus
sed. Hypocalcemia, large bowel involvement and missing histological ch
anges in lung tissue rather support the diagnosis of Crohn's disease,
particularly because the high CD4/CD8-quotient found in the bronchial
lavage is not only characteristic for sarcoidosis but also found in Cr
ohn's disease. Abdominal pain, diarrhea, night-sweat, weight loss and
inflammation parameters like CRP and anaemia normalized under therapy
with prednisone within a couple of months.