Abstract：
A 45-year-old man who was regularly followed up for Crohn\'s disease (CD) and maintained clinical remission with vedolizumab (VDZ). At 37 years old, he was diagnosed CD from longitudinal ulcers in the distal ileum by balloon-assisted enteroscopy (BAE). During the follow-up, liver enzyme elevation, splenomegaly and thrombocytopenia were in progress. Esophagogastric varices suggested chronic liver disease and portal hypertension. Magnetic resonance elastography (MRE) showed liver stiffness of 3.4 kPa and proton density fat fraction (PDFF) of 1.86%. He was diagnosed with granulomatous hepatitis based on a liver biopsy. The hepatic venous pressure gradient (HVPG) was mildly elevated at 7 mmHg, consistent with the pre-sinusoidal portal hypertension due to granulomatous hepatitis. We report a rare case with granulomatous hepatitis diagnosed from liver injury and portal hypertension, despite the stable intestinal symptoms of CD.
摘要：
一名45岁的男子定期随访克罗恩病（CD），并使用维多珠单抗（VDZ）维持临床缓解。37岁时，通过球囊辅助肠镜检查（BAE），他被诊断为回肠远端纵向溃疡。在后续行动中,肝酶升高，脾肿大和血小板减少正在进展中。食管胃静脉曲张提示慢性肝病和门脉高压。磁共振弹性成像（MRE）显示肝脏硬度为3.4kPa，质子密度脂肪分数（PDFF）为1.86％。根据肝活检，他被诊断为肉芽肿性肝炎。肝静脉压力梯度（HVPG）在7mmHg轻度升高，与肉芽肿性肝炎引起的窦前门静脉高压一致。我们报告了一例罕见的肉芽肿性肝炎，诊断为肝损伤和门静脉高压症，尽管CD的肠道症状稳定。
