Abstract
A 50-year-old woman was admitted to our hospital complaining of low grade fever and multiple arthralgia. On admission, she had a conjunctivitis in the right eye, an abdominal tumor with mild tenderness in the right lower quadrant and an erythema nodosum on the bilateral knees. Laboratory data indicated severe inflammatory signs (for example, WBC 12100/mm3, CRP 6+, ESR 93mm/1h). Barium enema showed the spastic ascending colon with multiple diverticula and the spastic terminal ileum with an irregular surface, but the longitudinal ulcer and the cobble stone appearance could not be found. Colonoscopic study showed normal mucosa of the colon, but a colonoscope could not be inserted into the terminal ileum. Ultrasonography and CT-scan at the right lower quadrant showed the terminal ileum with a narrowed lumen and a two-layered thick wall. The inner layer of the wall was considered as a muscular layer and the outer was considered as a fibro-fatty proliferation in the mesentery. The microscopic findings of the biopsied specimen from the cecum showed an epitheloid cell granuloma with a giant cell in the submucosa. Six weeks after the treatment of prednisolone and salazopyrin, Colonoscopic study showed the normal mucosa in the terminal ileum.
Therefore, this case was diagnosed as an early stage of Crohn's disease. Ultrasonography and CT-scan studies seemed to be useful in diagnosing this disease.