This is a fairly obscure question and, without meaning to underestimate the collective wisdom of my fellow dopers, I’m really hoping that gabriela, in particular, might be able to answer (Of course, if you do know the answer, please, please, don’t be shy).
I have a patient with longstanding but gradually worsening necrotizing granulomata in his abdominal and retroperitoneal lymph nodes (biopsy confirmed - with AFB and all other special stains negative). The largest node now measures 4 cm in max length. His primary complaint is severe abdominal pain, and he is also having fevers but no other constitutional symptoms.
The most interesting and confusing thing about this is that he has had Crohn’s disease for a number of years, albeit completely clinically inactive at this time. Even more intriguing IMO is that his abdominal symptoms first began, and radiographic evidence of the adenopathy was first detected, shortly after taking a course of high dose prednisone for a Crohn’s flair about four years ago.
He’s born in Canada, never had TB or TB exposure. CXR normal.
Besides hoping to get any additions to my list of differentials for necrotizing granulomata (fungal infections, cat scratch, LGV, TB, actinomycosis, Wegener’s, lymphoma, and rarely sarcoid), my question, and my purpose in posting this, gabriela, is to ask whether Crohn’s itself can lead to necrotizing granulomata in abdominal nodes? Any idea?
Thanks. I was aware of the 2nd article, in particular, and wondered whether similar cases existed where the abdominal nodes were involved (and not the lung). Appreciate your efforts!
I’m truly sorry, KarlGauss, but I have no expertise to add to this.
My chief area of expertise is in fatal disease, and necrotizing granulomata are rarely fatal. I have run across them as incidental and interesting findings, but that means my knowledge is completely anecdotal.
However, I am sure the Crohn disease cannot be irrelevant, since it is a disorder likely related to the imbalance between Th1 and Th2 responses, with Th1 aggressively elevated in Crohn, and Th2 in responses to helminthic infection, leading to my current favorite of all therapies, TSO (trichuris suis ova for Crohn disease, or drink a glass of pig whipworm eggs and feel better!). Pig whipworm egg therapy for Crohn disease
Necrotizing granulomata have been related to Th1 increases before now, outside the setting of Crohn’s (Gross WL, Trabandt A, Csernok E. Pathogenesis of Wegener’s granulomatosis. Ann Med Interne 1998; 149: 280; quoted in this article .
If consumption of something non-kosher is required to preserve life and health it IS permitted to Jews. Indeed, if the alternative is death such consumption is required as preservation of life takes precedence over just about anything else. Zev Steinhardt has covered that multiple times, as have other Jewish Dopers.
I should also say that I have been informed by a conservative rabbi that when the public health and welfare requires an autopsy of a Jewish person, that is one of the rare exceptions permitted by the (Talmud/Torah - don’t know the right word here).
Even when the Jewish person is a tragically dead eight year old girl whose father is a doctor who really doesn’t want her autopsied.
