Primary antibody deficiency and Crohn's disease

Five patients with primary antibody deficiency were investigated because of intermittent but persistent diarrhoea of several years duration despite im munoglobulin replacement therapy. We found no evidence of Giardia lambia or other intestinal pathogens to explain their gastrointestinal symptoms. All five had definite radiological evidence of small bowel Crohn's disease and three had histological specimens available with abnormalities consistent w ith Crohn's disease. One patient had a non-caseating granuloma in an oral u lcer. A second patient with stricturing disease in the small bowel had a mu cosal inflammatory infiltrate with non-caseating granulomas. A third had tr ansmural inflammation but no granulomas. All five patents were diagnosed as having Crohn's disease and have responded symptomatically to steroid thera py.