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In disguise as an acute flare: an unusual differential diagnosis of Crohn’s disease

J G Albert^1,2, F S Gittinger², M Hainz³, C Lübbert²

¹ Department of Medicine I, J.-W.-Goethe University Frankfurt, Germany
² First Department of Medicine, Martin-Luther-University, Halle (Saale), Germany
³ Department of Pathology, Martin-Luther-University, Halle (Saale), Germany

Correspondence to:
Dr J G Albert, Department of Medicine I, J-W-Goethe University Frankfurt, D-60590 Frankfurt/Main, Germany; joerg.albert@kgu.de

The first 150 words of the full text of this article appear below.

CLINICAL PRESENTATION

This 33-year-old man presented to our outpatient clinic with acute watery diarrhoea and abdominal cramps of 3 days duration suggesting an acute flare of Crohn’s disease. The disease had been diagnosed 3 years previously with terminal ileitis and was treated with temporary prednisolone and azathioprine 2.5 mg/kg body weight. So far, no abdominal operations had been performed. Clinical examination was inconspicuous except for a discrete abdominal pain on deep palpation in all four quadrants. Inflammatory markers were elevated (C-reactive protein = 57.8 mg/l; normal range: <5.0; leucocytes = 20.28x10⁹/litre; 3.80–9.80). Stool examination was negative for pathogens. Imaging demonstrated a thickening (5 mm) of the terminal ileum and mesenterial lymphadenopathy (fig 1), but ileo-colonoscopy did not reveal any signs of acute activity of Crohn’s disease. In oesophago-gastro-duodenoscopy an erythema of the gastric and duodenal mucosa was seen, specimens being taken for histopathological investigation (figs 2 . . . [Full text of this article]

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ANSWER
Gut 2009 58: 832. [Extract] [Full Text] [PDF]