A challenging case of multiple splenic and pancreatic lesions in a patient with Crohn's disease

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 days after laparoscopic surgery the patient developed a high fever (39°C) and diffuse abdominal pain associated with high CRP (300 mg/L) and leucocytosis (15 800 cells/μL). Repeated blood cultures, microbiological (including Yersinia enterocolitica) and serological samples (including HIV) were all negative. Additionally, she developed...
Source: Gut - Category: Gastroenterology Authors: Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research