Granulomatous ileitis in a patient with ankylosing spondylitis.

Background: A 21-year-old white male with a 3-year history of back pain presented with a 6-month history of weight loss (without significant gastrointestinal symptoms), lethargy and left hip pain, and diarrhea that had lasted 4 days.

Investigations: Barium follow-through, upper and lower gastrointestinal endoscopy and biopsies, capsule enteroscopy, CT of the chest and abdomen, measurement of the concentration of fecal calprotectin, intestinal absorption permeability test and wireless capsule endoscopy.

Diagnosis: Ankylosing spondylitis associated with ileitis of spondylarthropathy.

Management: Sulfasalazine and elemental diet, steroids, physiotherapy and bilateral hip replacement.