[Late initial manifestations of Crohn disease with atypical symptoms]

The case of a 55-year-old patient with Crohn's disease and chronic intermittent diarrhea as well as progressive weight loss of 20 percent of his body weight is reported. The establishment of the diagnosis was difficult at the beginning, since characteristic symptoms were missing and radiological and endoscopical findings were normal. Loam-coloured glossy stools, repeated registration of a reduced chymotrypsin concentration of the stool and the response of the symptoms to a substitution of pancreatic enzymes were initially regarded as signs of an exocrine pancreas insufficiency. Not before multiple biopsies were taken from the macroscopically largely normal small and large intestine during persisting complaints, an extensive infiltration with Crohn's disease could be shown. This case report emphasizes the importance of taking multiple biopsies in etiologically unexplained chronic diarrhea even from macroscopic inconspicuous intestinal mucosa. Because of the rising incidence of Crohn's disease late onset is gaining increasing significance in the differential diagnosis of chronic diarrhea in the elderly patients.