title: Crohn's disease and sarcoidosis: systemic granulomatosis?
abstract: We report an unusual case of severe Crohn's disease with involvement of the lung. In 1993 at age 21 a male patient experienced a Helicobacter-negative duodenitis. A routine chest radiograph revealed spotted opacities in the right upper lobe without discomfort and normal pulmonary function except for a reduced diffusion capacity. Bronchoalveolar lavage showed mild lymphocytosis and biopsies from the macroscopically normal bronchi displayed non-caseating granulomas. In 1995 he had symptoms of peptic ulcer disease with a gastric outlet stenosis. He underwent Billroth I resection with only temporary improvement. Three months later the symptoms had recurred and a stenosing inflammatory process of the duodenum was seen on endoscopy suggesting Crohn's disease. A chest radiograph demonstrated infiltrations in parts of the left lung and bronchoalveolar lavage again revealed alveolar lymphocytosis (CD4/CD8 ratio 3.1). Both the gastrointestinal and pulmonary affections responded to corticosteroids but the duodenal stricture had to be resected. The association of Crohn's disease and pulmonary disorders is discussed.
authors.affiliation: Department of Internal Medicine, Medical University of Lübeck, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Fellermann
authors.forename: M
authors.initials: M
authors.lastname: Stahl
authors.forename: K
authors.initials: K
authors.lastname: Dahlhoff
authors.forename: M
authors.initials: M
authors.lastname: Amthor
authors.forename: D
authors.initials: D
authors.lastname: Ludwig
authors.forename: E F
authors.initials: EF
authors.lastname: Stange
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001706:Biopsy; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D003424:Crohn Disease / Q000150:complications* / Q000628:therapy; D004386:Duodenum / Q000473:pathology; D005773:Gastroscopy; D006099:Granuloma / Q000503:physiopathology*; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D008218:Lymphocytosis / Q000175:diagnosis; D008297:Male; D054328:Proton Pump Inhibitors; D012507:Sarcoidosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D054328:Proton Pump Inhibitors