Diagnosed With Crohn's Disease. Didnot Have Any Surgery. Taking Imuran. Have Enlarged Spleen And Fatty Liver

Posted on Wed, 3 Apr 2013

Question: I am a 57 yr. female Crohn's diagnosed when I was 23yr. I have had serious bouts and then just the low grade/chronic maladies. I have never had surgery for this. Thirty years ago after a serious bout I was given packed red cells. I was told that my spleen needed to be removed as they were being lysed or destroyed. I pulled thru with No Surgery. After a routine colonscopy last year I was told the Chrohn's was active (Chr. pt. seem to be able to live with lots of malady) I can. I was also told to pick my poison. I started Imuran at 50mg increased to 90mg. Stayed on it only 4months...liver enzymes went up, fatigue and weight gain. I am not overweight or have ever been. I live in NYC and walk miles daily. Told to reduce it to 50mg however, I was due for a flu shot, went off and never started it again. Question Now, had an MRI for left hip/side pain by the family doctor...showed an enlarged spleen and fatty liver Feb. 12, 2013. Liver will restore over time, what is the best treatment for the enlarged spleen. I have never been fond of Surgery. Have a New Patient appt. at a top Dr. in 2wks here in NYC

Answered by Dr. Charles S Narasi (3 hours later)

Hello, XXXXXXX,
It is very commendable that you have been dealing with Crohn's
for over thirty years and have not had any kind of surgery.
The medication that you have been maintained on is an
Immune modulator family of drugs. In the recent years we
have newer effective medications that can maintain remission
very well. These are the biologic family. essentially they work
on tumor necrosis factor (Anti TNF ) through antibodies.
Remicade is the most commonly used drug with the most
experience. There are a number of other approved and also
experimental drugs to treat Crohn's. You have to be very
closely monitored with close supervision. Before you can
go on these type of drugs , you need to be screened for
Tuberculosis, other infections including fungal infections etc.
I am not sure if you have a separate condition that involves
the spleen such as Idiopathic Thrombocytopenia (Enlarged
spleen and low platelet count) which is an auto-immune disorder.
I am not sure if you were ever on steroids. One of the long term
side effects is "Osteoporosis" which can cause hip problems.
I am glad that you are seeing a specialist who can discuss all
the options for treating your Crohn's flare up.
I wish you the very best.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Charles S Narasi (40 minutes later)

I have been on most all the meds. Remicade is a problem because of the antibodies if you do not stay on it. It would be my last defense. Humira (sp?) put me in remission with my last bout. I have had scans for bone because of prednisone. You name it I've been on it. My biggest question is how to approach the enlarged spleen. The blogs have attributed it and fatty liver to Imuran. Can it shrink? If indeed it was the Imuran and not an autoimmune? Are there treatments(besides surgery) for the spleen? Thanks for your answer to the spleen questions in advance.

Answered by Dr. Charles S Narasi (5 hours later)

Hello, XXXXXXX,
You had never mentioned that you were already treated
with other medications. If you had problem with Remicade,
you would go on other drugs like Humira, or other medications
that are approved. As for Imuran, I don't think it caused your
spleen enlargement. As I mentioned before, you probably have
a separate or additional issue with the spleen.
As much as I can see, splenic enlargementand also fatty liver
is not related to Imuran but you have another problem.
I wish you well.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar