title: Gastrointestinal histopathology in chronic granulomatous disease: a study of 87 patients.
abstract: Gastrointestinal (GI) involvement in chronic granulomatous disease (CGD), a rare genetic immunodeficiency, mimics other inflammatory bowel diseases. We report GI pathology from 87 CGD patients seen at the NIH Clinical Center, with vague to severe clinical symptoms, in whom biopsies (313) had been evaluated (esophagus [23], stomach [71], small bowel [52] including duodenum [39], ileum [12], and jejunum [1], and colon [167]). Additionally reviewed was GI tissue from 15 autopsies. In our patient cohort, the mean age was 22 years (age range, 3 to 44 y; 2:1 male to female ratio). There were pathologic changes in 83/87 (95%) patients; with colon being the most commonly involved site and esophagus the least. There were microgranulomas in 53/87 (61%), pigmented macrophages in 64/87 (74%), tissue eosinophilia in 31/87 (36%), and chronic and/or acute inflammation in 57/87 (66%) patients. A subset of patients had villous shortening in the duodenum (8/39) and ileum (5/12). We identify microgranulomas in 76/167 (46%) colon, 12/52 (23%) small bowel, and 4/71 (6%) gastric biopsies; pigmented macrophages in 109/167 (65%) colon and 7/52 (13%) small bowel biopsies and 14/15 autopsies; chronic and/or acute inflammation in 97/167 (58%) colon, 13/52 (25%) small bowel, 42/71 (59%) gastric, and 5/23 (22%) esophageal biopsies; tissue eosinophilia in 43/167 (26%) colon, 7/52 (13%) small bowel, and 2/71 (3%) gastric biopsies. Only 4/87 (5%) patients had normal histology. No infectious etiology was identified in the majority of inflammatory lesions. We found that mild to severe GI pathology was common in CGD. In addition, microgranulomas, pigmented macrophages, and eosinophilia are not associated with acute (neutrophilic) inflammation.
authors.affiliation: *Laboratory of Pathology, National Cancer Institute, National Institutes of Health †National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases ‡National Institutes of Health, National Cancer Institute §National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD.
authors.forename: Meghna
authors.initials: M
authors.lastname: Alimchandani
authors.forename: Jin-Ping
authors.initials: JP
authors.lastname: Lai
authors.forename: Phyu Phyu
authors.initials: PP
authors.lastname: Aung
authors.forename: Sajneet
authors.initials: S
authors.lastname: Khangura
authors.forename: Natasha
authors.initials: N
authors.lastname: Kamal
authors.forename: John I
authors.initials: JI
authors.lastname: Gallin
authors.forename: Steven M
authors.initials: SM
authors.lastname: Holland
authors.forename: Harry L
authors.initials: HL
authors.lastname: Malech
authors.forename: Theo
authors.initials: T
authors.lastname: Heller
authors.forename: Markku
authors.initials: M
authors.lastname: Miettinen
authors.forename: Martha M
authors.initials: MM
authors.lastname: Quezado
mesh_terms: D000293:Adolescent; D000328:Adult; D001344:Autopsy; D001706:Biopsy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D041981:Gastrointestinal Tract / Q000276:immunology / Q000473:pathology*; D006105:Granulomatous Disease, Chronic / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult