[Differential diagnosis of granulomatous diseases--epithelioid cell granuloma in the intestine and liver in Crohn disease?]

Extraintestinal manifestations of Crohn's disease include a number of inflammatory diseases. The clinical activity of these associated diseases may in some cases parallel that of the intestinal inflammation. The activity of extraintestinal manifestations may however be paramount. A cause and effect relationship has not been shown for extraintestinal manifestations such as eye involvement, arthritis and accompanying hepatitis. The histological changes of extraintestinal manifestations consists of noncaseating granulomas that are difficult to distinguish from granulomas occurring in other systemic inflammatory diseases. This report is on a female patient with lower abdominal pain, fatigue, night-sweat, weight loss, episcleritis and diarrhea without blood and slime. Noncaseating granulomas were found in the colon and liver, but not in the lung. The differential diagnosis between the extrapulmonary manifestation of sarcoidosis and a generalized Crohn's disease is discussed. Hypocalcemia, large bowel involvement and missing histological changes 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 Crohn'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.