Laryngospasm as a single manifestation of epilepsy.

The presence in the hepatic granulomas of eosinophils raised the possibility of Toxocara infestation. Larval remnants were not present within the granulomas nor was there peripheral eosinophilia or any other manifestation of larval migration-for example chorioretinitis. Although there are numerous causes of hepatic granulomas the liver in this case showed features previously reported in extensive Crohn's diseaseO-namely pericholangitis, inflammation of the portal tracts, and increased fibrosis. How should we interpret the presence in our patient of virtual total villus atrophy? Two reports of the coexistance of Crohn's and coeliac diseases are extant7 8; each was associated with other evidence of classical Crohn's disease however, and upon withdrawal of dietary gluten there was clear histological evidence of mucosal recovery. In Crohn's disease per se, a variety of small-bowel mucosal abnormalities has been described.5 These are usually of a patchy nature and are most obvious adjacent to areas of frank mucosal ulceration. The case reported by Daum et al.3 was found initially to have mucosal changes suggestive of coeliac disease on jejunal biopsy but in comparison with our case, the abnormalities were not severe nor did symptoms remit after gluten withdrawal. Our patient requires further study to confirm persisting gluten sensitivity, nevertheless, it seems improbable that the abnormal jejunal histology is a manifestation of Crohn's disease per se.