Crohn's disease associated with systemic vasculitis, case report

Crohn's colitis is often associated with extraintestinal manifestations including local vasculitis, but systemic vasculitis is an exceptional rare finding. Characteristics of patients affected with both diseases have not been fully described.

We report the case of a 35 years old man with a medical history of Crohn's disease since 1989. (proved by histology), elevated obstructive liver enzymes since 1996. (supposed to be caused by primary sclerosing cholangitis) and recurrent upper respiratory tract infections since 1997. He was free of gastrointestinal symptoms for 10 years without treatment. In 2003. bronchial asthma was diagnosed. Because of the recurrent infections in July, 2004. functional endoscopic sinus surgery (FESS) was performed. He was transmitted to the GI department due to permanent fever and the deterioration of his condition supposing the relapse of his Crohn's disease. His cardiac status declined rapidly, cardiac failure occurred, caused by myocarditis according to ultrasound imaging. Peripheral blood eosinophilia was detected. No infectious or intestinal etiology could be identified. Thoracic and abdominal computed tomography, magnetic resonance imaging of the brain, biopsy of the bone marrow, the myocardium and the skin, molecular cytogenetic analysis of the bone marrow, cytology of the pleural fluid, viral serology (hepatitis B, C, HIV) were performed and immune serologic markers were investigated. The final consequence of the examinations was possible systemic vasculitis mostly Churg-Strauss syndrome, but Löffler's endocarditis could not be excluded either. The clinical response to high dose parenteral steroid and cyclophosphamid, accompanied by parenteral diuretics was good, so the patient's condition stabilized. No activity of the Crohn's disease was observed during our treatment period. His further observation and follow-up has been continued at the immunology department and further on at the cardiology department.