Wilkie Syndrome behind Crohn Disease? Superior Mesenteric Artery Syndrome Mimicking and Complicating Crohn Disease of the Upper Gastrointestinal Tract

loss (22% in the previous 6 months; body mass index 17). She had a history of gastric and duodenal peptic ulcers associated with Helicobacter pylori (Hp) infection, which led to Hp eradication in 2007. An upper endoscopy was performed, revealing an ulcerated pyloric stenosis, 4 duodenal ulcers (5–12 mm in diameter), a dilated duodenal bulb with cobblestone appearance, and a stricture in the third portion of the duodenum (D3) that could not be passed through ( Fig. 1 ). Gastric biopsies revealed chronic non-atrophic gastritis, and duodenal biopsies showed an intense chronic lymphoplasmacytic infiltrate of the mucosa and submucosa. No microorganisms (including Hp) or granulomas were identified. Biopsies of the stricture showed mucosal edema but no significant inflammatory infiltrate. Total colonoscopy with ileoscopy was normal. AntiSaccharomyces cerevisae antibodies (IgG-IgA) were positive (titer 1: 1,000). Given the persistence of gastroduodenal ulcers after previous optimal therapy for peptic disease as well as other endoscopic changes, chronic inflammation in the duodenal mucosa and submucosa, positive antiS. cerevisae antibodies, and a duodenal stenosis after ruling out other relevant conditions, we established the diagnosis of Crohn disease (CD) involving the upper gastrointestinal tract.