Misinterpretation of NSAID-induced Colopathy as Crohn’s Disease

Zusammenfassung

Die NSAR-induzierte Kolopathie mit Erosionen, Ulzera, Strikturen und Diaphragma-Bildungen ist zwar seit längerer Zeit bekannt, wird aber immer noch nicht selten endoskopisch und histologisch als „Morbus Crohn” fehlinterpretiert. Dies zeigt diese Kasuistik eines 39-jährigen Patienten mit blutiger Diarrhö und Stenose im Colon transversum, die histologisch als „vereinbar mit Morbus Crohn” gedeutet wurde. Die Glukokortikoidtherapie hatte jedoch nur Nebenwirkungen. Nach der operativen Therapie der Stenose persistierten die blutigen Diarrhöen, endoskopisch fanden sich wiederum Erosionen und Ulzera im Colon transversum. Auch die Umstellung der Therapie auf Azathioprin hatte nur Nebenwirkungen. Die konsiliarische Begutachtung der histologischen Präparate erbrachte dann die Verdachtsdiagnose einer NSAR-induzierten Kolopathie. Die Analyse der Krankengeschichte ergab, dass bei dem Patienten ein Morbus Bechterew bekannt war, der seit längerer Zeit mit Diclofenac behandelt wurde. Diese Kasuistik zeigt exemplarisch, dass die NSAR-induzierte Enterokolopathie bei Internisten, Gastroenterologen und Pathologen immer noch zu wenig bekannt und wegen des diskontinuierlichen endoskopischen und histologischen Befunds als „Morbus Crohn” fehlinterpretiert werden kann.

Abstract

Although NSAID-induced colonopathy characterised by erosions, ulcers, strictures and diaphragms has been known for quite some time, it is not infrequently misinterpreted endoscopically and histologically as Crohn’s disease. This is exemplified by the present case history of a 39-year-old man with bloody diarrhoea and a stenosis in the transverse colon that was histologically interpreted as ”consistent with Crohn’s disease”. Treatment with glucocorticoids, however, merely gave rise to adverse reactions. After surgical treatment of the stenosis, the episodes of bloody diarrhoea persisted, and endoscopy continued to reveal erosions and ulcers in the transverse colon. Changing treatment to azathioprine also failed to produce any positive response, merely causing side effects. Subsequent evaluation of the histological specimens by a consultant pathologist turned up the tentative diagnosis of NSAID-induced colonopathy. An analysis of the patient’s medical history revealed that he was suffering from Bechterew’s disease, for which he had long been taking diclofenac. This case history is a good example of the fact that NSAID-induced enterocolopathy is still too poorly recognised among internists, gastroenterologists and pathologists, and, on the basis of the discontinuous endoscopic and histological findings, is often misinterpreted as Crohn’s disease.

Schlüsselwörter

Morbus Crohn - NSAR-Kolopathie - ischämische Kolitis

Key words

Crohn’s disease - NSAID-induced colonopathy - ischaemic colitis

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