Peripheral neuropathy unrelated to vitamin deficiency or drug treatment is a rare extraintestinal complication of Crohn's disease. However, the occurrence of Graves disease with Crohn's disease and neuropathy is very unusual. and, to our knowledge, has not been previously described.

We report a 16 year-old African-American male who presented with chronic diarrhea, weight loss of 15 pounds, distal muscle weakness, and paraesthesia. Physical examination was remarkable for right 6th and bilateral 7th cranial nerve palsies, reduced distal muscle strength of upper and lower extremities, decreased sensation in both hands and absent deep tendon reflexes. Laboratory evaluation showed microcytic anemia, hypoalbuminemia, hypergammaglobulinemia, borderline elevated ANA titer, decreased C4 and normal vitamin B12 and folate in plasma. T3 and T4 were mildly increased and TSH decreased. TSH-receptor antiboby titers were elevated (43; normal <15). Nerve conduction studies revealed an acquired demyelinating neuropathy with moderate axonal injury and no chronic denervation. A sural nerve biopsy showed prerivascular inflammation. Upper endoscopy and colonoscopy with biopsies showed granulomatous colitis and duodenitis. The patient was initially treated with a 10 - day course of intravenous immunoglobulins with no clinical improvement. He then responded to oral prednisone and sulfasalazine. Seventeen moths later he developed clinical signs of hyperthyroidism and treatment with propylthioracil was stated. While Crohn's dosease and Graves disease remained in remission his peripheral neuropathy relapsed with tapering of steroids to an every-other-day schedule requiring additional treatment with azathioprine. We hypothesize that this patient has a rare autoimmune condition affecting the intestine, the thyroid gland as well as peripheral nerves.