Digestive Diseases and Sciences, Vol. 50, No. 10 (October 2005), p. 1950 ( C  2005) DOI: 10.1007/s10620-005-2966-1 LETTER TO THE EDITOR CROHN’S DISEASE IN LEUKEMIA: REPORT OF A CASE, WITH A REVIEW OF THE LITERATURE To the Editor: A 34-year-old man presented to our hospital with a history of upper respiratory tract infection. Complete blood count done elsewhere showed leukocytosis with a white cell count of 136,000/mm 3 , platelet count of 231,000/mm 3 , hemoglobin level of 10.5 g/dl, and hema- tocrit of 34.1%. The patient also reported a weight loss of 4 kg over the past 2 months. Upon admission the pa- tient was weak and pale. On examination splenomegaly was noted. Bone marrow aspiration with cytogenetic test- ing was diagnostic for chronic myeloid leukemia (CML), and 100% of the cells analyzed were positive for the Philadelphia chromosome (Ph). The patient was initially treated with interferon. During 7 years of follow-up, he was treated with hydroxyurea and then with imatinib me- sylate; he was doing well until he presented with abdomi- nal pain, diarrhea, and fever. On examination, he had dif- fuse abdominal pain and splenomegaly. Investigations did not show acute leukemic disease. The diagnosis of Crohn’s disease was made by colonoscopy and biopsies. The pa- tient was treated with azathioprine. His disease course was complicated with an enteric fistula that was treated surgi- cally. Now he is doing well. The association of inflammatory bowel disease (IBD) and malignancies has been reported in the literature, and case reports describe patients with either Crohn’s disease or ulcerative colitis who develop leukemias and myelodys- plastic syndromes (1–4). We searched the medical literature using the MEDLINE database from January 1966 through October 2004. The development of Crohn’s disease in a patient with chronic myeloid leukemia was only reported once (5). We report here the second case of a patient with CML who later developed Crohn’s disease. The relationship between the two conditions is unknown and the mechanism underlying the association between IBD and hematologic malignancy is poorly understood. Nevertheless, the immune status of our patient may play an important role in the pathogenesis of Crohn’s disease, in view of the responsibility of infec- tious processes in such a disease (6). On the other hand, the simultaneous occurrence of these two entities may be purely coincidental. There might be a possible pathogenic relationship be- tween the two entities, however, no significant conclusions regarding such an association can be drawn to support a causal relation. The publication of similar cases is encouraged in view of a possible relationship of these disorders. JAWAD A. MAKAREM, MD ZAHER K. OTROCK, MD ALA I. SHARARA, MD ALI T. T AHER, MD Department of Internal Medicine American University of Beirut Medical Center Beirut, Lebanon REFERENCES 1. Hatake K, Tanaka M, Muroi K, Miura Y: Leukaemia risk in Crohn’s disease. Lancet 347:1049–1050, 1996 2. Harewood GC, Loftus EV Jr., Tefferi A, Tremaine WJ, Sandborn WJ: Concurrent inflammatory bowel disease and myelodysplastic syndromes. Inflamm Bowel Dis 5:98–103, 1999 3. Mir Madjlessi SH, Farmer RG, Weick JK: Inflammatory bowel dis- ease and leukemia. A report of seven cases of leukemia in ulcerative colitis and Crohn’s disease and review of the literature. Dig Dis Sci 31:1025–1031, 1986 4. Orii S, Sugai T, Nakano O, Yoshinari H, Sato S: Acute promyelocytic leukemia in Crohn’s disease. Case report and review of the literature. J Clin Gastroenterol 13:325–327, 1991 5. Gutknecht J, Humbert P, Dupond JL, Mallet H: Leukemia and Crohn’s disease. Dig Dis Sci 31:1391, 1986 6. Wormann B, Sommer A, Ottenjann R: Association of herpes virus in- fection of the esophagus and idiopathic inflammatory bowel disease. Endoscopy 17:36–37, 1985 1950 Digestive Diseases and Sciences, Vol. 50, No. 10 (October 2005) 0163-2116/05/1000-1950/0 C  2005 Springer Science+Business Media, Inc.