Abstract:

One very well known to us 70-year-old patient with successful intralesional experimental therapy with interleukin-2 for abdominal mesothelioma (published in 2001) and local recurrence 14 years later, COPD and coronary heart disease, as well as with history of coxarthrosis for several years, was presented to us with an inflammatory syndrome and a slowly progressive anemia improved after the antibiotic treatment, and later development of real iron deficiency anemia. A sacroiliitis was proven by two bone histologies. Although the patient was without gastrointestinal disorders, a colonoscopy was performed and Crohn’s disease was established. We discussed: 1) Crohn’s disease with involvement of the joint; 2) bone metastasis from mesothelioma; 3) tuberculosis (based on histological evidence of bone granulomas, history of old pulmonary disease, and histology data of intestinal tuberculosis). Later the patient reported intake of NSAIDs for about two years. Despite the negative test, antituberculous (TB) medication was initiated. The conclusions from reviews of the biopsy samples varied from Crohn’s disease, ulcerative colitis, tuberculosis to ischemic colitis.  Control colonoscopy revealed cicatrices in the large bowel and few small erosions. We applied Methotrexate, despite the risk of recurrence of the mesothelioma. Methotrexate caused an expected lymphopenia. The subcutaneous interleukin-2 in low doses gradually normalized blood cell count and the status has been in control for 3 years.