Crohn's disease unmasks pulmonary sarcoidosis on biologic screening: dual granulomatous pathology responsive to infliximab.
Ezaam Fraz, Phillip Minh Tien Karpati, Denis Rubtsov et al.
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Case in brief
A man in his 30s with a history of ileal Crohn's disease was diagnosed with pulmonary sarcoidosis during routine pre-biologic screening, despite being asymptomatic. Lung function tests indicated mildly reduced diffusion capacity, and imaging revealed diffuse pulmonary nodules and mediastinal lymphadenopathy. Transbronchial biopsies confirmed non-necrotising granulomas. Treatment with infliximab led to improvement in both Crohn's disease and pulmonary sarcoidosis.
Diagnostic / clinical pearl
Clinicians should be aware that asymptomatic patients with Crohn's disease may have concurrent pulmonary sarcoidosis, which can be identified during routine evaluations.
Why it matters
This case underscores the importance of considering overlapping granulomatous diseases and the potential benefits of TNF-alpha inhibitors in managing dual pathologies.