We report the case of a 47-year-old male smoker of 10 cigarettes/day, diagnosed with ileocolic Crohn's disease at 20 years of age.
She had been operated on five occasions due to complications of her disease, performing wide intestinal resections (> 100 cm in total (> 100 cm), distal colon and sigmoid), with terminal ileum itself permanently ascendant colon being affected.
Due to corticodependent behavior, treatment with azathioprine 100 mg/24 hours adjusted to the enzymatic activity thiopurine-S-methyl transferase was initiated with good results initially.
One year after the start of treatment with azathioprine, the patient was admitted to the hospital with a diagnosis of the disease. Control laboratory tests showed thrombopenia (12 thrombopenia) and an analytical pattern of 55 UIPTGT, 143 UI GOTolysis.
Abdominal ultrasound and CT showed data of chronic liver disease with moderate hepatomegaly, increased caliber of the portal vein and little ascites as data of portal hypertension.
To complete the study an oral endoscopy showed small esophageal varices.
Subsequently, azathioprine was discontinued and a liver biopsy was performed via transjugular approach, which resulted in changes consistent with nodular regenerative hyperplasia (HNR) type sinusohistochemical pattern (CD10: + channel-K34), with
The manometric study by right jugular vein puncture showed a normal HVPG.
Six months later, a scheduled surgical intervention was performed due to retroperitoneal abscess dependent on small bowel loop with poor evolution of the disease, with previous overlapping ileum resection (cm) and a new intraoperative liver biopsy, resulting in pathological findings.
Given the short bowel situation and the persistence of inflammatory activity, adalimumab was started without complications and with excellent response after 1 year of follow-up.
