Cluster of Crohnʼs disease in Herny, France, including 2 cases from a common residence

To the Editor: During the fall of 2000 we became aware of a clustering of Crohn's disease (CD) in Herny, France, a small village located east of Metz, near the German border. Five cases had been recognized over a period of 36 years, from 1952 to 1988, in a population of ≈450. Two of the affected are cousins; the others are unrelated to the cousins or to one another. We interviewed 4 of the 5 from Herny (the fifth is deceased) along with 3 other individuals from adjacent villages, one with CD from Arriance, a community of 250, located 2.5 km from Herny, and a mother with CD and daughter with indeterminate colitis from Béchy, a town of 520, located 7 km from Herny. Interviews were conducted with informed consent. This research was approved by Le Comité Consultatif de Protection des Personnes dans la Recherche Biomédical de Lille, Hôpital Huriez, CHRU Lille, France, and the University of Connecticut Institutional Review Board. The first case occurred in 1952, in a boy age 14 who experienced fever, weight loss, anorexia, abdominal pain, diarrhea, and joint pain. X-rays documented his CD and surgery removed 30 cm of diseased distal ileum and right and transverse colon. The second, a younger male cousin, developed CD at age 21, in 1965. Similar to the first case, he had fever, weight loss, anorexia, abdominal pain, and diarrhea, but also reported blood in the stool. Diagnosis was confirmed by x-ray and subsequent surgery resected 29 cm of intestine. The now-deceased female neighbor (Case 3) had CD at age 35, in 1969. It has not been possible to detail her signs and symptoms, given patient records' protection laws; however, we have knowledge that she had surgery several times for her disease and died of unrelated causes. In 1984 a second woman acquired CD at age 36 (Case 4). She had fever, weight loss, anorexia, abdominal pain, diarrhea, and joint pain. Her diagnosis was confirmed by x-ray, but she has avoided surgery and is now 57. The most recent case (Case 5) occurred in a young man age 29, in 1988, 7 years after moving to Herny. He had fever, weight loss, abdominal pain, bowel perforation, and surgery, initially for appendectomy, then 5 years later for the removal of 1.5 m of intestine. What binds these cases together is that they occurred, over time, in a small village, where everyone knows one another. Figure 1 illustrates the close proximity of the homes within the neighborhood in which the CD originated. Affected individuals lived within 100 meters of one another, as next-door neighbors, as back-door neighbors, or as across-the-street neighbors (Fig. 2). Of particular interest is the fact that 2 patients, the deceased woman (Case 3) and the most recent patient (Case 5), lived at different times in the same residence (identified in Fig. 2). They developed CD in 1969 and 1988, respectively. Where these patients lived within the community is indicated in Figure 2; some resided in more than 1 home over the years. Photograph of the village of Herny, France, with surrounding agricultural land. Village diagram. The 5 CD patients lived at one time or another in the 6 houses indicated (X). XX identifies the residence that was home, at different times, to 2 unrelated CD patients. The black spot indicates the incriminated well. The patients and their doctors suspect that a common dug well from which household water was taken may have caused their disease. Each lives (or lived) within 60 meters of their source of potable water (Fig. 2). Herny is a small village of about 120 homes, surrounded by fields of wheat, potatoes, hay, and rolling hills. There are two wells in town; the cases occurred in close proximity to 1 of them. Water from this well is no longer used for human consumption. This cluster occurs under circumstances similar to those described in the parish of Blockley, Gloucestershire, England,1 and Mankato, Minnesota,2 incriminating a local water supply in the former and a high frequency of surface water pollution in the latter. In a recent study we recognized that familial Crohn's disease occurs in villages surrounded by tilled agricultural lands and that well water represents a risk factor (P ≤ 0.0001).3