Differential diagnosis between intestinal Behçet’s disease and Crohn’s disease：Discussion from a case difficult to distinguish between them

DOI
  • Nishida Daisuke
    Aichi Children’s Health and Medical Center, Infection and Immunology
  • Iwata Naomi
    Aichi Children’s Health and Medical Center, Infection and Immunology
  • Oohara Asami
    Aichi Children’s Health and Medical Center, Infection and Immunology
  • Kohagura Toaki
    Aichi Children’s Health and Medical Center, Infection and Immunology
  • Abe Naoki
    Aichi Children’s Health and Medical Center, Infection and Immunology
  • Nakaseko Haruna
    Aichi Children’s Health and Medical Center, Infection and Immunology
  • Kawabe Shinji
    Aichi Children’s Health and Medical Center, Infection and Immunology
  • Tanaka Masanori
    Hirosaki Municipal Hospital, Clinical Laboratory Department

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Other Title
  • 腸管ベーチェット病とクローン病の鑑別点：診断困難例 からの考察

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Abstract

Intestinal Behçet’s disease and Crohn’s disease share a clinical presentation of intestinal ulcers, as well as extra-intestinal manifestations such as oral aphthous ulcers, nodular erythema, and arthritis. We present a case who was difficult to distinguish between the two diseases. In addition, we discussed the differences of clinical features of them. The patient is 13-year-old girl. She initially had presented with fever, diarrhea, oral aphthous ulcers, nodular erythema of legs, and knee joint swelling. Gastrointestinal endoscopy revealed multiple ulcers, and histopathological examination showed nonspecific inflammatory cell infiltration. HLA-B51 testing had showed a positive result, and she had been diagnosed with intestinal Behçet’s disease. Although the symptoms improved after treatment with prednisolone, she developed a relapse accompanied with endoscopic histopathological findings of longitudinal ulcers, a cobblestone appearance of the mucosa, and non-caseating granuloma leading to a diagnosis of Crohn’s disease. We could not exclude the possibility that an allergic reaction to mesalazine altered her treatment course. We speculated that she initially had been diagnosed as intestinal Behçet’s disease for the evidences of no specific endoscopic findings of Crohn’s disease, extra-intestinal manifestations like as Behçet’s disease, HLA-B51 positive, and failure to reduce temperature by nutritional therapy. We suppose that Crohn’s disease seemed like as intestinal Behçet’s disease from the confusing clinical features.

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