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228 LYMPHOGRANULOMATOUS DISEASE: A UNIQUE COMPLICATION OF CROHN'S DISEASE IN PEDIATRICS S Destombe, AL Rougemont, JC Fournet, J Dubois, J Champagne, C Alfieri, P Ovetchkine, C Deslandres Lymphomatoid granulomatous (LG) is an angiocentric and angiodestructive B-cell lymphoproliferative disease with abnormal T-cell upregulation, associated with Epstein-Barr virus (EBV) infection. Three distinct grades of the disease are described, the most severe being considered as a subtype of diffuse large B-cell lymphoma. Immunosuppression is recognized as a facilitating agent in LG. We describe the case of a 17-year-old female with gastro-duodenal and ileocolonic Crohn's disease (CD) on 6-mercaptopurine for 6 years. Her Crohn's disease required multiple courses of corticotherapy, and semi-elemental diet. Her past medical history was significant for chalazions, uncomplicated zona (while on 6MP) and keratitis. Six weeks after a primary EBV infection she was readmitted for increasing pre-auricular nodes, cervical adenopathies, pharyngeal ulcerations, diffuse abdominal tenderness and bilateral serous otitis. She was then diagnosed with LG involving the lungs, the liver, the brain, the gastro-intestinal tract and the pharynx. Grading of the LG was different according to the organ involved. The lungs revealed a grade II LG whereas the pharyngeal ulcer revealed a diffuse large B-cell lymphoma, corresponding to a grade III LG. Three months after the diagnosis of LG the patient underwent ileal resection for bowel obstruction. Pathology revealed sequellae of the LG process. This case is unique because: LG has not so far been described in a pediatric patient with Crohn's disease; different grading of the disease was documented according to organ involved and to our knowledge a gastro-intestinal involvement has only been described in 3 other cases of LG. The patient remains in remission 2 years following diagnosis of LG after undergoing chemotherapy treatment for 13 months. Her treatment did not include anti-CD 20 immunotherapy. Her Crohn's disease has so far remained in remission off treatment.