This case report discusses a 60-year-old male patient with a history of suspected ulcerative colitis (UC) who was ultimately diagnosed with Crohn’s disease (CD). The patient presented with exocrine pancreatic insufficiency (EPI) and granulomatous inflammation in the pancreas. Although extraintestinal manifestations of inflammatory bowel disease (IBD) are known to occur, pancreatic complications are more frequently associated with CD than UC.
The patient was initially diagnosed with UC in 2013 and treated with mesalamine. However, he continued to experience persistent loose stools and fecal urgency, prompting further investigation. Despite normal inflammatory markers, colonoscopy revealed mild inflammation, and biopsies indicated active colitis. Additional tests ruled out infectious causes, and fecal elastase testing suggested EPI.
An endoscopic ultrasound identified a hypoechoic lesion in the pancreas, and fine needle aspiration confirmed chronic granulomatous inflammation. This finding indicated a possible extraintestinal manifestation of CD. A small bowel video capsule endoscopy revealed ulcers throughout the small bowel, leading to a revision of the patient’s diagnosis from UC to CD.
Treatment with prednisone and subsequently infliximab led to a significant improvement in the patient’s symptoms, allowing him to stop pancreatic enzyme supplementation. This case highlights the importance of recognizing pancreatic manifestations in patients with CD, especially when granulomatous inflammation occurs outside typical locations. It emphasizes that clinicians should consider the pancreas as a potential site for extraintestinal manifestations of IBD, especially in cases where the clinical presentation does not align with initial diagnoses.
https://journals.lww.com/acgcr/fulltext/2024/08000/crohn_s_disease_associated_granulomatous.5.aspx