DIFFERENTIAL-DIAGNOSIS OF GRANULOMATOUS D ISEASES - INTESTINAL AND HEPATIC NONCASEATING GRANULOMAS IN CROHNS-DISEASE

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.