Crohn's disease mimicking sarcoidosis in bronchoalveolar lavage

Granulomatous disorders like sarcoidosis or Crohn's disease are commonly as sociated with extrapulmonary or extraintestinal manifestations which occasi onally may represent the only symptoms. We describe a 28-year-old female pa tient suffering from atypical erythema nodosum and arthritis. Although the chest x-ray was unremarkable bronchoalveolar ravage revealed lymphocytic al veolitis with an elevated CD4/CD8 ratio of 8 and 11.4 at repeated examinati ons suggesting a diagnosis of sarcoidosis, Further diagnostic workup includ ed endoscopy of the bowel, The macroscopic aspect and histology of the term inal small bowel and colon ascendens indicated Crohn's disease, The patient recovered on steroids and sulfasalazine. Six months later she developed a perianal abscess for which she needed surgery supporting the diagnosis of C rohn's disease. This is the first case of a significantly (>6) elevated CD4 /CD8 ratio in Crohn's disease previously regarded as highly specific for sa rcoidosis.