2102 Crohn’s Disease With Rare Extra-Intestinal Manifestation and Unusual Great Outcome!!

Abstract

INTRODUCTION: Crohn’s disease (CD) is a chronic relapsing inflammatory disorder that most commonly affects the small and large bowel. Prolonged diarrhea with abdominal pain, with or without gross bleeding, fatigue, and weight loss are the hallmarks of Crohn’s disease. Extraintestinal manifestations, such as joints, eye and skin disorders, biliary tract involvement, and kidney stones, may occur. Tonsillar involvement in CD has been very rarely described in the literature. CD is diagnosed with endoscopic and imaging studies of the bowel in a patient with a compatible clinical history. We present a 29-year-old female patient who had a rare extra-intentional manifestation of Crohn's disease which is granulomatous tonsillitis and had an unexpectedly favorable outcome post-tonsillectomy being off treatment for 9 years now without any complaints. CASE DESCRIPTION/METHODS: A 29-year-old with no past medical history presented with frequent episodes of tonsillitis followed by prolonged diarrhea with abdominal pain. Physical exam showed enlarged tonsils and generalized lower abdominal tenderness. Labs showed elevated C-reactive protein, Sedimentation rate, and fecal calprotectin. The patient underwent colonoscopy that showed scattered ileocolitis and biopsy results were compatible with Crohn’s disease. Patient’s tonsillitis failed multiple courses of antibiotic therapy. Accordingly, tonsillectomy was performed, and biopsy showed granulomatous lesion consistent with Crohn’s disease. The patient has been off treatment and never required maintenance therapy for 9 years now without any complaints. DISCUSSION: The first case of CD with granulomatous tonsillitis was reported in 1984. CD patients with an oropharyngeal manifestation of their disease are rare, with an estimation of only 0.5%–20% of patients, with a higher incidence in younger patients. A systematic review and meta-analysis did by Sun et al. demonstrated that tonsillectomy in healthy individuals is associated with an increased risk of developing Crohn’s Disease. Koutroubakis et al. did a case-control study that also showed the same results. Our case presented with recurrent tonsillar pain initially which is a rare extra-intestinal manifestation and underwent tonsillectomy with biopsy confirming Crohn’s Disease and had a remarkably unusual recovery from all Crohn’s Disease symptoms and never had any complaints in 9 years off medical treatment.