ABSTRACT

Grand Round: Mycobacterium paratuberculosis cervical lymphadenitis, followed five years later by terminal ileitis similar to Crohn's disease

John Hermon-Taylor, professor of surgery,^a Nick Barnes, consultant paediatrician,^b Chris Clarke, senior lecturer in veterinary pathology,^c Caroline Finlayson, consultant senior lecturer in histopathology^d
a Department of Surgery, St George's Hospital Medical School, London SW17 0RE, ^b Children's Services, Addenbrooke's Hospital, Cambridge CB2 2QQ, ^c Department of Veterinary Pathology, University of Edinburgh, Veterinary Field Station, Easter Bush, Roslin, Midlothian EH25 9RG, ^d Department of Histopathology, St George's Hospital Medical School

SUMMARY: In September 1988 a seven year old boy living in a village outside Cambridge, developed non-tuberculous mycobacterial cervical lymphadenitis. The nodes were removed and later shown to contain abundant Mycobacterium paratuberculosis. This pathogen causes chronic inflammation of the intestine ranging from a pluribacillary 'lepromatous' type to a paucimicrobial 'tuberculoid' type, in many species of animals including primates. Five years later he presented with chronic inflammation of the intestine affecting the terminal ileum and ascending colon, similar to Crohn's disease. This resolved on prolonged treatment with a combination of rifabutin and clarithromycin, leaving a healed ileal scar which required excision. As with M. bovis earlier this century, infection with M. paratuberculosis was probably acquired by the consumption of milk contaminated with these robust versatile organisms.

PARA's SUMMARY

SEE LETTER BY DRS BARNES: "Extraintestinal disease may be associated with Crohn's disease"