Pulmonary Crohn’s Disease

Excerpt

A 31-year-old man of Northern European ancestry who was born and raised in California was well until 2013 when he developed a perianal fistula. At that time, he had no diarrhea, abdominal pain, or weight loss. Anal examination under anesthesia revealed a deep right, transsphincteric hemi-horseshoe anal fistulous tract that extended from the right posterior to the right anterior midline. Laboratory evaluation was notable for a normal complete blood count and comprehensive metabolic panel, although serum inflammatory markers were mildly elevated (ESR 33 mm/h, CRP 1.5 mg/dL). …