Association of Crohn’s Disease and Hepatic Cirrhosis Post-Primary Sclerosing Cholangitis: A Case Report

Primary sclerosing cholangitis (PSC) is a distinct entity associated with inflammatory bowel disease (IBD). We report the case of a 49-year-old patient with ileocecal Crohn’s disease of the stenosing phenotype, presenting with perianal lesions in the form of fistulas, who was diagnosed with PSC complicated by hepatic cirrhosis following the development of clinical and biological cholestasis, as well as his first ascitic decompensation. After initiating treatment with azathioprine for Crohn's, he experienced significant abdominal pain, ascites, and jaundice, leading to further investigations. MRI revealed bile duct stenosis, and endoscopic procedures confirmed portal hypertension. After excluding secondary causes, a diagnosis of PSC was made. Treatment with methotrexate and ursodeoxycholic acid resulted in clinical improvement. The discussion emphasizes the rare but notable association between Crohn's disease and PSC, outlining diagnostic challenges and management strategies. It highlights the poor prognosis linked to PSC, including risks of cirrhosis and colorectal cancer, with recommendations for regular monitoring and surveillance for dysplasia in patients with both conditions. Overall, the study underscores the need for careful management and ongoing research into effective treatments for this challenging dual diagnosis.