Granulomatous disorders like sarcoidosis or Crohn’s disease are commonly associated with extrapulmonary or extraintestinal manifestations which occasionally may represent the only symptoms. We describe a 28-year-old female patient suffering from atypical erythema nodosum and arthritis. Although the chest x-ray was unremarkable bronchoalveolar lavage revealed lymphocytic alveolitis with an elevated CD4/CD8 ratio of 8 and 11.4 at repeated examinations suggesting a diagnosis of sarcoidosis. Further diagnostic workup included endoscopy of the bowel. The macroscopic aspect and histology of the terminal small bowel and colon ascendens indicated Crohn’s disease. The patient recovered on steroids and sulfasalazine. Six months later she developed a perianal abscess for which she needed surgery supporting the diagnosis of Crohn’s disease. This is the first case of a significantly (>6) elevated CD4/CD8 ratio in Crohn’s disease previously regarded as highly specific for sarcoidosis.

1.
Lynch JP 3rd, Kazerooni EA, Gay SE: Pulmonary sarcoidosis. Clin Chest Med 1997;18:755–785.
2.
Podolsky DK: Inflammatory bowel disease. N Engl J Med 1991;325:1008–1016.
3.
Maña J, Teirstein AS, Mendelson DS, Padilla ML, DePalo LR: Excessive thoracic computed tomography scanning in sarcoidosis. Thorax 1995;50:1264–1266.
4.
Bunting PS, Szalai JP, Katic M: Diagnostic aspects of angiotensin converting enzyme in pulmonary sarcoidosis. Clin Biochem 1987;20:213–219.
5.
Costabel U: Sarkoidose; in Atlas der bronchoalveolären Lavage. Stuttgart, Thieme, 1994, p 18.
6.
Winterbauer RH, Lammert J, Selland M, Wu R, Corley D, Springmeyer SC: Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis. Chest 1993;104:352–361.
7.
Bonniere P, Waellert B, Cortot A, Marchandise X, Riou Y, Tonnel AB, Colombel JF, Voisin C, Paris J, Voisin C: Latent pulmonary involvement in Crohn’s disease: Biological, functional, bronchoalveolar lavage and scintigraphic studies. Gut 1986;27:919–925.
8.
Waellert B, Colombel JF, Tonnel AB, Bonniere P, Cortot A, Paris JC, et al: Evidence of lymphocytic alveolitis in Crohn’s disease. Chest 1985;87:363–367.
9.
Müller-Quernheim J, Kronke M, Strausz J, Schykowski M, Ferlinz R: Interleukin-2 receptor gene expression by bronchoalveolar lavage lymphocytes in pulmonary sarcoidosis. Am Rev Respir Dis 1989;140:82–88.
10.
Schoenfeld N, Schmitt M, Remy N, Ellensohn P, Loddenkemper R, Wahn U: Activation of bronchoalveolar lavage T lymphocytes and clinical, functional and radiological features in sarcoidosis. Sarcoidosis 1995;12:135–139.
11.
Mueller C, Knoflach, P, Zielinski CC: T-cell activation in Crohn’s disease. Increased levels of soluble interleukin-2 receptor in serum and in supernatants of stimulated peripheral blood mononuclear cells. Gastroenterology 1990;98:639–646.
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