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Abstract

Crohn�s disease is a form of inflammatory bowel disease that typically presents with abdominal pain, weight loss and bloody diarrhoea. Sweet�s syndrome is a neutrophilic dermatosis which presents with erythematous papules and is associated with Crohn�s disease amongst other conditions. We present an unusual case of a 35-year old lady with Crohn�s disease where abdominal pain, extensive mesenteric lymphadenopathy and Sweet�s syndrome were the initial presenting features. We describe how diagnostic uncertainty led to extensive investigations and recurrent admissions. Initially the patient was treated as having Yersinia infection due to suggestive histology although serology was negative. Yersinia infection, gastrointestinal tuberculosis and Crohn�s disease may have similar radiological and histological appearances so differentiation can be difficult. We discuss the impact of delayed diagnosis (17 months) and share some interesting points on the difficulties of diagnosing Crohn�s disease on mesenteric lymph node histology alone, especially when macroscopic examination of the bowel wall is normal. Treatment for Crohn�s disease resulted in improvement of her symptoms and return to work. maria.birnie@doctors.org.uk

Biography