Granulomatous hepatitis with Crohn's disease: a case report

Tatsuya Suzuki; Yuka Hayakawa; Shun Kaneko; Kento Takenaka; Keiya Watakabe; Yuko Kinowaki; Akira Takemoto; Kazuo Ohtsuka; Yasuhiro Asahina; Ryuichi Okamoto

doi:10.1007/s12328-024-01937-8

Granulomatous hepatitis with Crohn's disease: a case report

Clin J Gastroenterol. 2024 Mar 19. doi: 10.1007/s12328-024-01937-8. Online ahead of print.

Authors

Affiliations

¹ Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
² Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan. s-kaneko.gast@tmd.ac.jp.
³ Department of Comprehensive Pathology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
⁴ Bioresource Research Center, Tokyo Medical and Dental University, Tokyo, Japan.
⁵ Endoscopic Unit, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
⁶ Department of Liver Disease Control, Tokyo Medical and Dental University, Tokyo, Japan.

PMID: 38502473
DOI: 10.1007/s12328-024-01937-8

Abstract

A 45-year-old man who was regularly followed up for Crohn's disease (CD) and maintained clinical remission with vedolizumab (VDZ). At 37 years old, he was diagnosed CD from longitudinal ulcers in the distal ileum by balloon-assisted enteroscopy (BAE). During the follow-up, liver enzyme elevation, splenomegaly and thrombocytopenia were in progress. Esophagogastric varices suggested chronic liver disease and portal hypertension. Magnetic resonance elastography (MRE) showed liver stiffness of 3.4 kPa and proton density fat fraction (PDFF) of 1.86%. He was diagnosed with granulomatous hepatitis based on a liver biopsy. The hepatic venous pressure gradient (HVPG) was mildly elevated at 7 mmHg, consistent with the pre-sinusoidal portal hypertension due to granulomatous hepatitis. We report a rare case with granulomatous hepatitis diagnosed from liver injury and portal hypertension, despite the stable intestinal symptoms of CD.

Keywords: Crohn’s disease; Extra-intestinal manifestations; Granulomatous hepatitis; Portal hypertension.