Doubts and similarities between Crohn's disease and Henoch-Schönlein purpura.

A 22 year-old man without previous diseases came to emergency room for purpuric cutaneous lesions at elbows, tibial surfaces and feet appeared eight days before preceded by a selflimited catarrhal process. Following the patient was examined for abdominal pain, vomit, diarrhea and knees, ankles and wrist arthritis. The physical examination did not show others data of particular interest. Laboratory examination underlined leukocytes 13,230/mm3 with slight neutrophilia, PCR 40 mg/L, proteinuria and ketone bodies in urine. A Henoch-Schönlein purpura (HSP) was diagnosed and the patient was treated with prednisone 30 mg per day p.o. Two days later, because of increasing abdominal pain, dark liquid stools and vomit, the patient came back to emergency room. The physical exam showed increased borborygmi, painful palpation of right iliac fossa without signs of peritonism and toes purpuriforme exanthema but no buttock rash, and arthritis. The analysis detected PCR 34 mg/l, ferritina 352 ng/mL, alpha 1 globulin 9%, alpha 2 globulin 13%, leukocytes 17,670/mm3. Abdominal ultrasound demonstrated enlargement of the wall of an ileal loop. Computed tomography (CT) confirmed the enlarged and thickened terminal ileum, hypervascularized ascending colon mucosa and moderate amount of intra-abdominal free fluid (Fig. 1). Upper gastrointestinal endoscopy did not describe remarkable findings. Serology of Yersinia and Anisakis and stool examination were negative. At colonoscopy the mucosa of ileum showed edematous and erythematous irregular areas with pseudo-polypoid appearance. Biopsies show ed a slight unspecific chronic inflammation of the terminal ileum. At 35 cm from the anus there were different aphthous lesions that biopsy showed unspecific. During hospitalization the patient received metilpredinisolone i.v. 1 mg/kg daily and symptoms and proteinuria disappeared. Seven days later an intestinal follow-through did not show any sign of ileitis. Corticosteroid doses were tapered gradually and the patient remained asymptomatic.