Liver Abscess Secondary to Crohn's Disease: A Case Report.

Crohn's disease (CD) is a type of inflammatory bowel disease (IBD) and extra-intestinal manifestations are common. Although common features of CD include fistulation and abscess formation, they typically manifest exclusively in the lower gastrointestinal (GI) tract and in patients who do not have adequate control over their disease. Pyogenic liver abscess is rare in the general population and is an unusual and extra-intestinal manifestation of CD. Herein, we present a patient with Crohn's ileo-colitis who presented with generalized abdominal pain and fevers and was found to have multiple pyogenic liver abscesses biopsy-proven to be secondary to CD. The patient's liver abscesses were refractory to repeated CT-guided drainage and antibiotic therapy. This paper illustrates a rare condition in the general population and those with CD. We intend to discuss the differences of pyogenic liver abscesses in CD compared to the general population, the rarity of this presentation and propose a unique mechanism by which the patient may have developed this liver abscess. It is common for clinicians to mistake the diagnosis of febrile illness with or without abdominal pain as a simple reactivation of CD, and thus it is important to keep pyogenic liver abscess on the differential even if their disease state is otherwise well controlled.

Isolated IgG4 Autoimmune Cholangitis in the Absence of Pancreatitis.

The IgG4-related disease is an uncommon immune-mediated condition affecting multiple organ systems concomitantly; however, it is very rare for a patient to have isolated IgG4 autoimmune cholangitis or IgG4-related disease confined to the hepatobiliary system. The majority of cases are associated with pancreatitis and are incidentally discovered in the workup of acute or chronic pancreatitis. When it affects the hepatobiliary system, it develops as inflammatory fibrosclerosing cholangitis, which can mimic other hepatobiliary diseases such as primary sclerosing cholangitis. Herein, we present a case of type 1 IgG4 autoimmune cholangitis in the absence of pancreatitis. Our case is particularly unique because type 1 is the most common type associated with autoimmune pancreatitis; however, our patient had type 1 without any evidence of pancreatic involvement. Additionally, like most cases of isolated IgG4 autoimmune cholangitis, our patient was refractory to standard therapy. This case highlights the clinical significance, rarity and severity of isolated IgG4 autoimmune cholangitis.