Mimic Crohn Disease Research Articles

Can Lymphoma Mimic Crohn's Disease?

Can Lymphoma Mimic Crohn's Disease?

ABCL-253 Can Lymphoma Mimic Crohn's Disease?

ABCL-253 Can Lymphoma Mimic Crohn's Disease?

Tacrolimus-Associated Terminal Ileitis After Kidney Transplantation, Mimicking Crohn Disease: A Case Report

The onset of gastroduodenal ulcers is a frequent complication after transplantation, whereas cases of intestinal ulcers are sporadic and poorly described in the literature. A patient on immunosuppressive therapy with tacrolimus and mycophenolate mofetil after kidney transplant for immunoglobulin A-related glomerulonephritis developed symptoms compatible with Crohn disease 7 months after the transplant. The patient was hospitalized for abdominal pain, diarrhea, fever, and weight loss. Imaging and a colonoscopy showed signs of idiopathic inflammatory bowel disease (IBD) affecting the terminal ileum. Behcet's disease, post-transplant lymphoma, cytomegalovirus, Epstein-Barr virus, or mycobacteria infection were excluded. Mycophenolate mofetil was suspended, and steroid therapy was increased without clinical improvement. Eleven units of blood were required for severe anemia. A further colonoscopy revealed ulcerations involving the cecal fundus, ileocecal valve, and distal ileum with bowel stenosis and suspected ischemia. The patient, therefore, underwent an emergency laparoscopic ileocolic resection. The histologic examination did not reveal clear signs of IBD, ischemia, or viral infection of the ileum. The findings seemed indicative of iatrogenic damage from immunosuppressive therapy. The postoperative course was regular, and after 12 months, the patient was asymptomatic, on low-dose tacrolimus and prednisone therapy. During immunosuppressive therapy, the onset of isolated ileal ulcers, which can mimic IBD, may be a sporadic complication.

Interval appendicitis shows histological differences from acute appendicitis and may mimic Crohn disease and other forms of granulomatous appendicitis.

While patients presenting with clinical signs and symptoms of acute appendicitis (AA) often receive surgical intervention shortly after presentation, certain patients may instead receive non-operative management initially, with appendectomy later. The histology of such interval appendicitis (IA) has only been described in small series. Also, we have noticed a recent increase in the incidence of IA specimens at our institution. We identified appendectomy specimens in our department during 2018 with available haematoxylin and eosin slides and electronic clinical data, and evaluated multiple histological findings. Cases were then divided into AA and IA, based on clinical history (AA if the patient presented to the hospital within 1 week of symptom onset and underwent appendectomy within 48 h; IA if appendectomy was delayed at least 1 week). Changes between groups were compared. The cohort included 165 cases (125 AA, 40 IA). Findings significantly more common in AA included mucosal acute inflammation, mural acute inflammation and acute serositis. Findings significantly more common in IA included Crohn-like mural inflammation, mural fibrosis, goblet cell hyperplasia, granulomas, xanthogranulomatous inflammation, haemosiderin-laden macrophages and granulation tissue. The rate of IA in 2018 (24%) was noticeably higher than in previous years. Acute inflammatory changes are more common in AA but can remain present in IA. Mural fibrosis, serosal adhesions, haemosiderin-laden macrophages and granulation tissue suggest IA. Granulomas and xanthogranulomatous inflammation can also be seen in IA, and Crohn-like mural inflammation is not uncommon. These histological patterns can guide signout and prevent diagnostic errors, particularly when clinical information is unavailable.

Therapeutic Effects of Anti-Inflammatory N-Acylhydrazones in the Resolution of Experimental Colitis.

Inflammatory bowel diseases are caused by inflammation of the gastrointestinal tract, which may or may not have a specific cause or pathogen. They affect millions of people around the world and there are still few effective treatments. The aim of this work is to investigate the anti-inflammatory effect of the IKK-β inhibitor LASSBio-1524 and its three analogs, LASSBio-1760, LASSBio-1763, and LASSBio-1764, on mediator production and expression of inflammatory enzymes using experimental animal models of intestinal inflammatory diseases. Colitis was performed using two different models, which mimic Crohn disease (induced by dinitrobenzene acid) and ulcerative colitis (induced by sodium dextran sulfate) in mice. In both models, a therapeutic protocol with a daily dose of 1, 3, or 30 μmol/kg was performed. LASSBio-1524 and its three analogs reduced the secretion of tumor necrosis factor-α, IL-1β, IL-6, IL-12, and IFN-γ and increased secretion of IL-10, protecting gastrointestinal homeostasis. All compounds reduced macro- and microscopic colonic damage caused by experimental colitis and p38 mitogen-activated protein kinase expression in the colon, as well as leukocytosis and anemia resulting from the disease. Our data may suggest LASSBio-1524 and its analogs (LASSBio-1760, LASSBio-1763, and LASSBio-1764) as promising candidates for new prototypes designed to treat inflammatory bowel diseases. SIGNIFICANCE STATEMENT: Three new N-acylhydrazones were synthetized as analogs of LASSBio-1524. All new substances were evaluated in dextran sulfate- and dinitrobenzene acid-induced colitis, with LASSBio-1760, LASSBio-1762, and LASSBio-1763 presenting a significant effect in both models of colitis without toxic effects. The new substances could be considered as a new prototype for the development of new anti-inflammatory treatments of colitis.

Sarcoidosis Mimicking Crohn Disease

Abstract Intestinal sarcoidosis can mimic Crohn disease (CD), and it is important to evaluate for alternative diagnoses in patients who present with atypical symptoms or do not respond to conventional therapy. Furthermore, CD, with or without biologic therapy, has been associated with neurological symptoms including neuropathies, myelopathies, thromboembolic, and demyelinating diseases leading to diagnostic uncertainty. We present a case of sarcoidosis of the luminal gastrointestinal tract and central nervous system, which mimicked the presentation of CD. This case highlights the need to expand the differential diagnosis in patients who present with atypical symptoms and do not respond to biologic therapy.

Schistosomiasis with Recto-Vaginal Fistula Mimicking Crohn's Disease in an Immunocompromised Patient and the Surgical Management

Schistosomiasis with Recto-Vaginal Fistula Mimicking Crohn's Disease in an Immunocompromised Patient and the Surgical Management

Evaluation of anti-inflammatory effect of silver-coated glass beads in mice with experimentally induced colitis as a new type of treatment in inflammatory bowel disease.

Recent studies point at the anti-inflammatory action of silver through induction of apoptosis of inflammatory cells via oxidative stress, promotion of wound healing as well as antimicrobial effect. Our aim was to design a new formulation based on silver and validate its anti-inflammatory activity in the mouse models of colitis. Silver-coated glass beads were prepared using a magnetron sputtering method and a standard magnetron sputtering gun equipped with pure silver target. Colitis was induced by the ic administration of TNBS into colon (to mimic Crohn's disease) and addition of DSS to drinking water (to imitate ulcerative colitis). Evaluation of inflammation was performed based on macroscopic and microscopic scoring, quantification of the myeloperoxidase activity and colonic microflora analysis. Silver-coated glass beads administered ic alleviated intestinal inflammation in mouse models of colitis, induced by TNBS and DSS. This alleviation of colitis resulted principally from changes in the gut microflora. The anti-inflammatory action of the new formulation was associated predominantly with the presence of the silver nanolayer on the beads, and to a lesser extent the size of glass polymer units. The application of the newly developed formulation employing silver-coated glass beads has the potential to be translated to clinical conditions for the efficient treatment of IBD.

Eosinophilic Colitis Masquerading as Malignancy of Colon

A 78-year-old woman presented to the ER with the chief complaint of generalized, dull abdominal pain for three days duration. She described the pain to be continuous and not related to eating. The patient also reported multiple episodes of hematochezia for a week preceding the presentation. The patient noted weight loss of about 30 pounds over a six month period. The patient denied having any diarrhea. Her medical comorbidities included hypertension, diabetes mellitus type 2, coronary artery disease, bronchial asthma and End-stage Renal Disease (ESRD) requiring renal replacement therapy. Laboratory values were significant for normocytic normochromic anemia with hemoglobin of 11 grams/dL and mild eosinophilia with a count of 0.4x103/uL. Patient underwent a Computerized Tomography (CT) scan of abdomen and pelvis which showed a focal circumferential mass like thickening in the colon with paracolic infiltration (Figure-1). A colonoscopy revealed discontiguous areas of circumferential ulcerated, friable mucosa from hepatic flexure to descending colon (Figure-2). Biopsies from these areas showed numerous eosinophils within the lamina propria suggestive of eosinophilic colitis (Figure-3). EC (Eosinophilic colitis) is the rarest form of eosinophilic gastroenteritis. It is more commonly seen in neonates and children. However, there have been a few cases of EC reported in adults predominantly in their third and fourth decades of life. Estimating the true incidence of primary EC is challenging given its rare nature, and also since secondary EC can occur in a multitude of other chronic conditions such as food allergies and inflammatory bowel diseases. Symptoms of EC usually include abdominal pain, diarrhea, bleeding, weight loss, obstruction, and in more severe cases ascites. Transmural disease has been reported to be associated with intestinal obstruction, intussusception, and even perforation. Colonic distention, thickening of the bowel wall and ulcerated lesions mimicking Crohn disease have been reported, as seen in our patient. On colonoscopy, signs of colitis such as mucosal erythema, edema, and ulcerated lesions are often evident. The management of eosinophilic gastroenteritis varies, depending on the underlying condition. Eosinophilic gastroenteritis associated with peripheral eosinophilia and positive IgE- is often caused by food allergy and was shown to respond to diet restriction. For other etiologies, corticosteroids remain the mainstay of therapy.Figure 1Figure 2Figure 3

Nonneoplastic Diseases of the Small Intestine: Clinical, Pathophysiologic, and Imaging Characteristics

AJR:201, September 2013 ma, and mucosal hyperenhancement. These changes are commonly seen in Crohn disease, but many other nonneoplastic diseases of the small intestine can also produce these imaging findings. Clinical information is often vital in discriminating between potential mimics of Crohn disease, such as ulcerative jejunoileitis and infectious and eosinophilic enteritis, but the radiologist should also be aware of a number of imaging clues that may aid in the differentiation. First, a diagnosis of Crohn disease can be more specifically inferred when these changes are asymmetric and preferentially involve the mesenteric border of the bowel wall. Crohn disease typically results in multisegmental discontinuous disease, whereas graft-versus-host disease (GVHD), angioedema, and generalized intestinal ischemia typically result in more diffuse involvement of the small intestine. The presence of perienteric signs, such as mesenteric fibrofatty proliferation, is characteristic of Crohn disease. In this article, we review the important clinical, pathophysiologic, and imaging characteristics of a wide range of nonneoplastic disorders of the small intestine, including immune-mediated, infectious, and vascular-related disorders, some of which may occasionally mimic Crohn disease.

Primary Jejunal Diffuse Large B-Cell Lymphoma with Multiple Skip Ulcers and Perforation Mimicking Crohn's Disease

Most primary intestinal lymphomas are single exophytic or annular tumor masses with diffuse large B-cell lymphoma (DLBCL) as the most common histological type. Crohn's disease is a chronic inflammatory bowel disease with multiple skip ulcers. Here we reported the case of an elderly male presented with hollow organ perforation. Segmental resection of the jejunum revealed 5 skip ulcers, grossly mimicking Crohn's disease. Pathological examination revealed diffuse sheets of large neoplastic cells expressing CD20, bcl-2, bcl-6 and MUM1 but not CD3 or CD10, a DLBCL of nongerminal center B-cell phenotype. In situ hybridization for Epstein-Barr virus was negative. Locus-specific interphase fluorescence in situ hybridization assay showed negative results for chromosomal aberrations at the IGH, BCL2, BCL6 and MYC loci. The clinical staging was IE and the patient received rituximab and combination chemotherapy. He was in complete remission for 14 months but unfortunately succumbed to an unidentified central nervous system infection 4 months later without evidence of tumor recurrence. Although multiple skip ulcers mimicked Crohn's disease, they were transverse in direction as opposed to the usual longitudinal ulcers in Crohn's disease. The correct diagnosis was reached by careful histopathological examination and ancillary studies.

Terminal Ileitis Caused by Yersinia pseudotuberculosis Mimicking Crohn Disease in Childhood

Terminal Ileitis Caused by <i>Yersinia pseudotuberculosis</i> Mimicking Crohn Disease in Childhood

Changes Induced by Colonic Stents Mimic Crohn Disease

Malignancies involving the colorectum can obstruct the lumen. A self-expanding stent placed under endoscopic guidance in the obstructed area alleviates obstruction and postpones or avoids emergency surgery. If clinically indicated, the affected, stented segment is resected. The stent (Wallflex, Boston Scientific, Boston, MA) consists of wires arranged in …

Colorectal Stents Orient Specimens and Induce Artifacts That Mimic Crohn Disease

Colorectal malignancies may be stented to alleviate obstruction. The stent is a polarized and braided network of metallic wires. Pathology associated with colorectal stents is yet to be described. The authors reviewed 7 cases involving stented colorectal segments from patients lacking clinical suspicion of Crohn disease. In 4 cases, orientation of the specimens and stents matched the corresponding anatomic landmarks. In 3 cases, the specimens lacked helpful anatomic landmarks, and orientation was possible only after correlating with the intrinsic polarity of the stents. Stented areas showed artifacts resembling Crohn disease, including rounded cobblestones, pseudopolyps, and simple fissures, as well as unique artifacts including rhomboid cobblestones, complex fissures, oblique fissures with remarkably straight edges, and conical fragments of tissue that appeared to float. Crohn disease was misdiagnosed in 1 case in which the stent was removed intraoperatively and was never received. Colorectal stents help orient ambiguous specimens and induce patterned injury that can be confused with Crohn disease.

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

Henoch-Schonlein Purpura (HSP) is the most common systemic vasculitis in childhood. The diagnostic criteria include palpable purpura with at least one other manifestation -- abdominal pain, IgA deposition, arthritis or arthralgia, or renal involvement. Immune complex deposits result in necrosis of the wall of small- and medium-sized arteries with infiltration of tissue by neutrophils and deposition of nuclear fragments, a process called leukocytoclastic vasculitis (LCV). It is often associated with infections, medications, or tumors. It may coexist with or mimic Crohn's disease. Periumbilical and epigastric pain worsens with meals, from bowel angina. Bleeding is usually occult or, less commonly, associated with melena. Intussusception, the most common surgical complication, is usually ileo-ileo or ileo-colic. Perforations, usually ileal, may occur spontaneously or be associated with intussusception. Ultrasound, recommended as the first diagnostic test, and CT scans may show intussusception and asymmetric bowel wall thickening mainly involving the jejunum and ileum. There are a range of endoscopic findings including gastritis, duodenitis, ulceration, and purpura, with the second portion of the duodenum characteristically being involved more than the bulb. Intestinal biopsies show IgA deposition and LCV in the submucosal vessels. Superficial biopsies may show inflammation, ulceration, edema, hemorrhage, and vascular congestion, presumably due to vasculitis-induced mucosal ischemia. The efficacy of corticosteroids in preventing severe complications or relapses is controversial. The majority of patients, however, improve spontaneously.

Infectious Colitis Mimicking Crohnʼs Disease

There have been rare case reports of infectious diarrhea mimicking Crohn's disease. We present two cases of infectious colitis in which the endoscopic and radiographic features, and in one case, biopsies, mimic Crohn's disease. Case #1: A 46 year-old woman presented with 4 days of bloody diarrhea up to 10 times a day and lower abdominal cramps, nausea, and vomiting. She was afebrile and had mild tenderness in her right upper abdomen. She had a normal WBC and a HCT of 27. Multiple stool cultures, including for C. difficile, and ova and parasite tests were negative. CT scan showed diffuse colitis from the sigmoid to the cecum with pericolonic infiltrative changes. Colonoscopy revealed patchy erythema, edema, and ulcers in the cecum and the ascending colon. She was started on mesalamine and IV steroids, as well as antibiotics. Colon biopsies revealed just mucosal erosions. Viral stool cultures were ordered, and were positive for adenovirus.[figure1]FigureCase #2: A 34 year-old man presented with 6 days of nausea, vomiting, and diarrhea up to 15 times a day, with fevers and chills. WBC was normal, fecal leukocytes were >20, and stool cultures were negative. Abdominal CT revealed thickening and stranding around the right colon and terminal ileum. Colonoscopy revealed edema, erythema, and petechiae in a patchy distribution from the rectum to the cecum. A small superficial ulcer was seen in the rectum. The patient was started on mesalamine and antibiotics. Biopsies revealed active, chronic inflammation in the terminal ileum and colon, with glandular architectural distortion. Blood cultures were positive for Salmonella.[figure2]FigureDiscussion: These two cases highlight the rare, but very real, possibilities of infectious colitis mimicking Crohn's disease. These would seem to favor delaying steroids and other aggressive options considered in the “top-down” approach until infectious etiologies are ruled out.

Diversion of the Fecal Stream Resolves Ulcerative Colitis Complicating Chronic Granulomatous Disease in an Adult Patient

Chronic granulomatous disease (CGD) is a primary phagocytic disorder characterized by greatly increased susceptibility to severe bacterial and fungal infections. Patients with CGD may have gastrointestinal manifestations, commonly colitis, usually mimicking Crohn disease. We report an adult case, the second in literature, of CGD with severe colitis displaying histologic features of ulcerative colitis. The patient had a prompt improvement (continuing up to more than 5 y of follow-up) of the clinical picture after ileostomy and fecal diversion.

Wegener Granulomatosis Mimicking Inflammatory Bowel Disease in a Pediatric Patient

Wegener Granulomatosis Mimicking Inflammatory Bowel Disease in a Pediatric Patient