Department of Internal Medicine, University of SANKO, TurkeyFulltext PDF
The aim of this study was to report an unusual case of Langerhans Cell Histiocytosis (LCH) with terminal ileum and lung involvement which mimics Crohn's disease. A 42-year-old male patient presented to our clinic with the complaints of intermittent diarrhea and abdominal pain in which he stated such complaints have continued almost along a year frequently. Colonoscopic examination revealed geographically shaped large ulcers with a deep-bottomed located the terminal ileum which initially suggests the diagnosis of Crohn's disease. Following treatment with azathioprine and budesonide, diarrhea regressed but abdominal pain persisted. In the third month of treatment, the patient re-presented with the complaints of cough, sputum and chest pain. Thorax CT followed by PET CT examination revealed multiple lung nodules suggesting malignancy. Histopathological examination of the nodules collected by segmentectomy further revealed that they were rich in histiocytic cells and positive for S-100 protein and CD1a antigen. When the terminal ileum biopsies of the patient with lung LCH were examined for a second time, histiocytic cells confirm the diagnosis of LCH through positive immune histochemical staining with CD-1a. The patient was administrated with prednisolone 1 mg/kg and then combined with vinblastine. LCH may present with the ulcers mimicking Crohn's disease. Therefore, the possibility of LCH should be always kept in mind in the cases of non-response to the treatment for Crohn's disease or when non-gastrointestinal atypical symptoms develop.
Crohn's disease; Langerhans cell histiocytosis; Gastrointestinal system
Yılmaz N. Langerhans Cell Histiocytosis Mimicking Crohn’s Disease: a Case Report and Review of the Literature. Ann Clin Case Rep. 2020; 5: 1817.