[Are granulomas necessary for the final diagnosis of Crohn disease?]

A case of a 38 year-old male patient, from Lima, with a three-year period illness, characterized by abdominal pain, diarrhea, ponderal weight loss and fever is showed. He is examined by colonoscopy, with endoscopic diagnosis of colon cancer and undergoes surgery. The histopathological diagnosis was severe acute and chronic ulcerative ileocolitis, suggesting Crohn disease. A month later he again showed abdominal pain, diarrhea and fever, so a new colonoscopy is performed revealing multiple ileum ulcers and in the anastomotic area. The biopsy revealed an acute and chronic inflammatory process. The colon radiography showed a filling defect and irregularity in the cecum, and the upper endoscopy revealed esophageal ulcers. In addition, a number of analyses were carried out, such as: coproculture, HIV, and VK on sputum and feces, as well as CEA dosage, resulting all of them negative. The thorax radiography was also normal.He was diagnosed with Crohn's disease and was treated with mesalacin. Evolution was fast, showing weight gain, which allowed the discharge of the patient from the hospital seven (7) days later. The anatomical pathology never did confirm the final diagnosis, which brings us to the question:Are the granulomas always necessary for the final diagnosis of Crohn's disease?