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Abnormal technetium labelled white cell scan in the colitis of chronic granulomatous disease
S Hoare1, J E Walsh, E Eastham
1Paediatric Department, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne.
Insights
Chronic granulomatous disease (CGD) can mimic Crohn's disease in children with colitis. This mimicry is evident in clinical presentation, histology, and imaging, necessitating consideration of CGD in atypical cases.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Rare Diseases
Background:
- Crohn's disease is a common inflammatory bowel disease in children.
- Diagnosis relies on clinical, endoscopic, histological, and imaging data.
- Atypical presentations can complicate diagnosis.
Observation:
- A child initially diagnosed with Crohn's disease presented with severe colitis.
- Septicemia caused by an unusual organism prompted further investigation.
- This led to a definitive diagnosis of chronic granulomatous disease (CGD).
Findings:
- Granulomatous colitis in CGD is clinically, histologically, and on radiolabeled white cell scans, indistinguishable from Crohn's disease.
- Atypical presentations of colitis warrant consideration of CGD.
Implications:
- CGD should be included in the differential diagnosis for pediatric granulomatous colitis.
- Infection with unusual pseudomonads in children with colitis should prompt exclusion of CGD.
Abstract:
A child with colitis was treated for Crohn's disease, diagnosed on history, clinical and colonoscopic findings, radiolabelled white cell bowel scan, and colonic histology. After septicaemia caused by an unusual organism, further investigation lead to a diagnosis of chronic granulomatous disease (CGD). The granulomatous colitis of CGD is clinically, histologically, and on white cell scanning, indistinguishable from that in Crohn's disease and should be considered in atypical cases. Infection with unusual 'pseudomonads' should prompt the exclusion of this disorder.