Crohn's disease is a granulomatous inflammatory bowel disease with characteristic
histopathological findings. Any part of the gastrointestinal tract can be involved,
but it is extremely rare to find cases when it spreads beyond the intestinal structures.
We present a case of a woman with extraintestinal Crohn's disease in the left kidney,
mimicking renal tumor. Rare cases reported in the literature describe involvement
of the inner ear, the nasal cavity, supraglottic structures, glottis, and skin, but
not that of the kidneys.
A 51-year-old female patient with a previous history of two colonic resections due
to Crohn's disease presented in January 2010 actually with rectovaginal fistula. She
had a 20yrs history of Crohn's disease. There was no response to steroids, and azathioprin
was not tolerated because of hypertensive events. Anti-TNF-α therapy was considered.
CT-enteroclysis was performed to evaluate the small bowel involvement before starting
biological therapy, and a mass lesion of the left kidney was revealed. Ultrasound-guided
fine needle biopsy was considered, but nephrectomy was carried out. Histological examination
of the surgical specimen surprisingly described a typical granulomatous inflammatory
pattern, and excluded malignancy. Our case is the first presentation of Crohn's disease
localized in the kidney. Fine needle biopsy could have made the nephrectomy avoidable,
which emphasizes the importance of preoperative biopsy taking.
