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A challenging case of multiple splenic and pancreatic lesions in a patient with Crohn's disease
  1. G Boschetti1,
  2. S Assaad2,
  3. B Balme3,
  4. S Boyer1,
  5. B Flourié1,
  6. S Nancey1
  1. 1 Department of Gastroenterology, Lyon-Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
  2. 2 Internal Medicine Department, Saint-Luc Saint-Joseph Hospital, Lyon, France
  3. 3 Department of Pathology, Saint-Luc Saint-Joseph Hospital, Lyon, France
  1. Correspondence to Professor S Nancey, Department of Gastroenterology, Lyon-Sud University Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite 69495, France; Stephane.nancey{at}chu-lyon.fr

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A 40-year-old woman with a history of ileocolonic Crohn's disease treated with oral mesalamine presented with fever and diffuse abdominal pain without diarrhoea. Laboratory tests were notable only for increased serum C-reactive protein (CRP) (46 mg/L) and leucocytosis (10 100 cells/μL) with neutrophilia (8700 cells/μL). Abdominal CT revealed multiple mesenteric lymph nodes (MLNs) without evidence of thickening of the bowel wall or complications such as stricture, fistula or abscess. Laparoscopic biopsy samples of some MLNs were performed; their histopathological analysis revealed a suppurative lymphadenitis, with a strong infiltration by neutrophils, oedema and tissue necrosis without granuloma or identification of any micro-organisms, including alcohol acid-resistant bacilli (AARB). Three …

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