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Birgitta Wimmer, Dieter Plamenig, Maria M. Gilg, Werner Fortunat, Cord Langner, Granulomatous duodenitis mimicking Crohn's disease caused by Capnocytophaga sp., Inflammatory Bowel Diseases, Volume 17, Issue 6, 1 June 2011, Pages E31–E32, https://doi.org/10.1002/ibd.21645
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Extract
To the Editor:
A granuloma is a collection of cells of the mononuclear phagocyte series. It consists of epithelioid cells, i.e., activated macrophages transformed into epithelium-like cells, surrounded by a collar of mononuclear leukocytes, principally lymphocytes and occasionally plasma cells. In the gastrointestinal tract granulomas are considered a hallmark of the histopathological diagnosis of Crohn's disease (CD). Thus, in the upper gastrointestinal tract focally enhanced gastritis and/or granulomas may be observed in 40%-75% of CD patients.1,2
Case Report
A 44-year-old female presented with nausea, vomiting, and epigastric pain for 5 days. Stool habits were normal. There were neither relevant past medical history nor travel abroad. The patient's temperature was within normal limits. Laboratory tests showed increased leukocytes (14,900/μL [normal range 3,900-10,200]) and increased C-reactive protein (CRP) (6.22 mg/dL [normal <0.5 mg/dL]).
Upper gastrointestinal endoscopy demonstrated diffuse swelling, redness, and friability of the duodenal mucosa, extending into the distal part of the stomach (Fig. 1A). Magnetic resonance imaging (MRI) performed to rule out malignancy showed marked edema with diffuse thickening of the duodenal wall consistent with chronic inflammation.
