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• W2316842941 abstract "Crohn's Disease (CD) is often characterized by the presence of inflammatory granulomas in the intestines as well as tissues such as the liver and gallbladder. We report a case of granulomatous hepatitis and clinical cholecystitis as the initial presentation of CD in an adolescent male. Sixteen-year-old adolescent male presented to Harbor-UCLA Medical Center Emergency Department complaining of a weeklong history of worsening abdominal pain, vomiting, and fever. Further history revealed intermittent diarrhea and a fifteen-pound weight loss over the course of a year. On exam, the abdomen was tender, especially over the right hypochondrium, with noticeable rebound but no overt peritoneal signs. Blood tests showed elevated AST and ALT twice above normal range, a total bilirubin of 2.7 mg/dL that was primarily direct, and an elevated C-reactive protein. Stool was positive for blood and pus, but CBC and electrolytes were normal. A liver ultrasound was significant for gallbladder sludge and splenomegaly. Patient was given fluid and intravenous antibiotics and was admitted for further evaluation. Surgery was consulted and ordered an abdominal scan that revealed an abnormal liver with a heterogeneous texture, pericholecystic fluid, splenomegaly, and a diffusely thickened terminal ileum with surrounding lymphadenopathy. Cholescintigraphy was notable for delayed clearance of the blood pool and a severely impaired gallbladder ejection fraction of eight percent. The patient underwent upper and lower endoscopy with the latter demonstrating severe inflammation of the cecum and deep, lineal ulceration of the terminal ileum (Figure 1). Histology confirmed the diagnosis of CD, noting chronic inflammation and nonceating granulomas. Surprisingly, liver biopsy was positive for multiple, giant noncaseating granulomas with parenchymal inflammation (Figures 2 and 3). Copper stain was negative. Cholecystectomy was considered but deferred due to the patient's clinical improvement on antibiotics, steroids, and enteral nutritional (EN). The patient has maintained clinical remission with enteric budesonide, partial EN, and 6-mercaptopurine. Fissuring ulcer in cecum (black arrow). Granulomatous hepatitis. Note giant cell (black arrow) within granuloma (blue arrow). The clinical presentation of right upper quadrant pain associated with vomiting, fever, and cholestasis is consistent with gallbladder dysfunction. Acalculus cholecystitis has been described in long-standing CD; granulomas are found within the livers of about 8% of patients with CD.i,ii,iii,iv This is the first reported finding of such entities at the initial presentation of CD. We suspect that granulomatous inflammation of the gallbladder in our patient was responsible for its dysfunction. Repeat cholescintigraphy, liver biopsy, and colonoscopy will shed further light on this interesting and complicated case." @default.
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• W2316842941 date "2009-12-01" @default.
• W2316842941 modified "2023-10-14" @default.
• W2316842941 title "Granulomatous Hepatitis and Acalculus Cholecystitis in an adolescent male with newly diagnosed Crohnʼs Disease: A Case Report" @default.
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• W2316842941 doi "https://doi.org/10.1097/00054725-200912002-00019" @default.
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