Interesting case of dual pathology: Crohn’s disease and Peutz-Jeghers syndrome

An 18-year-old man presented with fever, night sweats and progressive weight loss over 2 months. He had a history of Peutz-Jeghers syndrome (PJS) complicated by previous intussusception requiring left hemicolectomy. Colonoscopy revealed deep punched out ulceration throughout the colon with multiple polyps. He was investigated for tuberculosis based on his occupation as dairy farmer. Following a negative QuantiFERON test, he was started on infliximab as emergency therapy and made a good recovery at 6 months follow-up. We describe a case of newly diagnosed Crohn’s disease (CD) in an adolescent with a background diagnosis of PJS. While inflammatory bowel disease, such as CD, is common in the UK, the association with PJS is very rare, with only two existing case reports in the literature.

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Inflammatory bowel disease: introduction

10.1093/med/9780198569862.003.0041 ◽

2011 ◽

Cited By ~ 1

Author(s):

R. Mark Beattie ◽

Anil Dhawan ◽

John W.L. Puntis

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Family History ◽

Crohn's Disease ◽

Bowel Disease ◽

History Of ◽

Inflammatory Bowel ◽

The Uk

Inflammatory bowel disease 288• 25 % of inflammatory bowel disease (IBD) presents in childhood, usually as Crohn's disease or ulcerative colitis. The UK incidence is 5.2/100 000 children <16 years of age. Crohn's disease is the more common. Family history of Crohn's disease or ulcerative colitis is common. Both diseases can occur in the same family....

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Myopericarditis as an Extra-Intestinal Manifestation of Crohn’s Disease: A Case Report

Clinical Cardiology and Cardiovascular Interventions ◽

10.31579/2641-0419/241 ◽

2022 ◽

Vol 5 (1) ◽

pp. 01-05

Author(s):

Rohan Prasad ◽

Surya Chennupati ◽

Tyler Kemnic ◽

Abdullah Al-abcha ◽

Manel Boumegouas ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Case Reports ◽

Case Presentation ◽

Reactive Protein ◽

History Of ◽

St Elevation ◽

Inflammatory Bowel ◽

Small Pericardial Effusion

Introduction: Myopericarditis is an uncommon manifestation of Crohn’s disease. Interestingly enough, it can present in a patient without any acute bowel symptoms. Case Presentation: A 21-year-old male with a medical history of Crohn’s disease and eosinophilic esophagitis presented to the hospital with chest pain and fever. Blood work revealed elevated troponin, C-reactive protein, and sedimentation rate levels. Electrocardiogram (EKG) showed diffuse ST elevation in all leads. Transthoracic echocardiogram (TTE) demonstrated a small pericardial effusion without valvular abnormalities. The patient was diagnosed with myopericarditis. Extensive etiological workup was negative, in the absence of other explanations, it was attributed to his Crohn’s disease. The patient was started on colchicine and ibuprofen. Out-patient follow-up revealed resolution of symptoms. Conclusion: This case reports the rare occurrence of myopericarditis and Crohn’s disease. Inflammatory bowel disease as a cause of myopericarditis has been reported in some cases within the literature; however, there is no definitive mechanism known.

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Immune Thrombocytopenic Purpura (ITP) as an Uncommon Extraintestinal Complication of Crohn’s Disease: Case Vignette and Systematic Literature Review

Case Reports in Hematology ◽

10.1155/2020/4785759 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Raisa Epistola ◽

Tiffanie Do ◽

Ritika Vankina ◽

Daniel Wu ◽

James Yeh ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Immune Thrombocytopenic Purpura ◽

Case Reports ◽

Case Vignette ◽

Mucosal Permeability ◽

Extraintestinal Manifestation ◽

Thrombocytopenic Purpura ◽

Disease Case ◽

Inflammatory Bowel

While the association of immune thrombocytopenic purpura (ITP) and inflammatory bowel disease (IBD) has been described in a few case reports, management of ITP as an extraintestinal manifestation of Crohn’s disease (CD) is less studied. There are approximately a dozen cases describing the management of patients dually diagnosed with CD/ITP. Previous reports postulated that the mechanism of ITP in CD was through the presence of circulating immune complexes in the serum and antigenic mimicry due to increased mucosal permeability in active colitis, versus increased mucosal production of TH1-type proinflammatory cytokines during CD flares, which may account for remission of ITP with surgery for CD. We present a case of a 27-year-old man who presented with medically refractory CD and ITP who responded to surgical management with colectomy and splenectomy, along with a systematic review of the literature. These cases suggest that colectomy should be considered in the treatment of medically refractory ITP among patients with concomitant CD.

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Inflammatory bowel disease: a beast of burden

10.33178/boolean.2011.13 ◽

2011 ◽

pp. 57-61

Author(s):

Dawn Farrell

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Social Life ◽

Symptom Burden ◽

Complex Disorders ◽

Inflammatory Bowel ◽

The Uk

Imagine having to empty your bowel eight or ten times a day and experiencing constant panic and fear about the location of toilet facilities. Imagine experiencing constant tiredness that impacts on all aspects of your life including work, family and social life. These are just two examples of experiences commonly suffered by individuals with a condition called inflammatory bowel disease. These people are burdened with symptoms which impact on their daily lives. This research aims to provide healthcare professionals with an understanding of the extent to which individuals with inflammatory bowel disease experience symptom burden and to identify what symptoms are most problematic. Crohn’s disease and ulcerative colitis collectively termed as inflammatory bowel disease are complex disorders. In the United Kingdom, collectively Crohn’s disease and ulcerative colitis affects approximately one person in every 250 of the population. Ulcerative colitis affects up to 120,000 people in the UK, or every 1 ...

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Profuse Diarrhea after Misoprostol Use in a Patient with a History of Crohn's Disease

Annals of Pharmacotherapy ◽

10.1177/106002809202600910 ◽

1992 ◽

Vol 26 (9) ◽

pp. 1092-1093 ◽

Cited By ~ 5

Author(s):

Julie S. Johnson ◽

James A. Karboski ◽

Glenys O. Williams

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Case Reports ◽

Data Extraction ◽

Gastrointestinal Symptoms ◽

Personal Communication ◽

Watery Diarrhea ◽

Synthetic Analog ◽

Ulcer Disease ◽

History Of

OBJECTIVE: To report a case of profuse diarrhea after misoprostol use in a patient with a history of Crohn's disease and to discuss the role of eicosanoids in Crohn's disease. DATA SOURCES: Patient medical records, case reports, review articles identified by MEDLINE, and personal communication with the physician, patient, and manufacturer. DATA EXTRACTION: From interviews, the manufacturer, and pertinent published sources by one author and reviewed by the others. DATA SYNTHESIS: A 55-year-old woman presented to clinic complaining of multiple joint pains. Her medical history was significant for peptic ulcer disease, hypertension, and Crohn's disease in remission since May 1989. Her joint pains were treated with ibuprofen 600 mg po qid and misoprostol 200 μg po qid (after meals and at bedtime). Following the administration of three doses of ibuprofen and misoprostol, the patient experienced abdominal cramps, pain, and voluminous, watery diarrhea for two days. Upon discontinuation of the ibuprofen and misoprostol, all of her gastrointestinal symptoms resolved within 12 hours. Rechallenge with ibuprofen alone failed to produce a recurrence of symptoms. Enhanced synthesis of intestinal eicosanoids has been demonstrated in Crohn's disease. Misoprostol, a synthetic analog of one of the eicosanoids, could induce a flare-up of Crohn's disease as suggested in this patient. CONCLUSIONS: Misoprostol should be used with caution in patients with known inflammatory bowel disease.

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Crohn’s disease severity in familial and sporadic cases

Gut ◽

10.1136/gut.44.1.91 ◽

1999 ◽

Vol 44 (1) ◽

pp. 91-95 ◽

Cited By ~ 44

Author(s):

F Carbonnel ◽

G Macaigne ◽

L Beaugerie ◽

J P Gendre ◽

J Cosnes

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Family History ◽

Crohn's Disease ◽

Disease Severity ◽

Bowel Disease ◽

History Of ◽

Sporadic Cases ◽

Inflammatory Bowel ◽

Excisional Surgery

BackgroundHaving a relative with inflammatory bowel disease increases the risk for Crohn’s disease but may also increase its severity in affected patients.AimsTo evaluate the influence of a family history on Crohn’s disease course and severity.Methods1316 patients followed in the same unit were studied retrospectively. Age at onset, duration of illness, site, and extent of disease were determined in patients with and without a family history. Additionally, disease severity was estimated by the need for medical therapy (steroid and immunosuppressive requirement) and the frequency and extent of excisional surgery.Results152 (12%) patients had a family history of inflammatory bowel disease. Duration of follow up was longer in patients with a family history and there were more operations for perforating complications in familial cases. However, the importance of medical therapy, and the incidence and extent of excisional surgery were similar in familial and and sporadic cases. Kaplan-Meier estimated time to prescription of immunosuppressive drugs and first intestinal resection were similar in familial and sporadic cases. When the 152 patients with familial Crohn’s disease were paired for sex, location of disease at onset, date of birth, and date of diagnosis with 152 patients with sporadic Crohn’s disease, the disease severity remained similar in the two groups of paired patients.ConclusionPatients with Crohn’s disease and a family history of inflammatory bowel disease do not have a more severe course.

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Natural History of Very Early Onset Inflammatory Bowel Disease in North America: A Retrospective Cohort Study

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa080 ◽

2020 ◽

Cited By ~ 2

Author(s):

Basavaraj Kerur ◽

Eric I Benchimol ◽

Karoline Fiedler ◽

Marisa Stahl ◽

Jeffrey Hyams ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Early Onset ◽

Bowel Surgery ◽

Age Of Diagnosis ◽

History Of ◽

Inflammatory Bowel

Abstract Background The incidence of very early onset inflammatory bowel disease (VEOIBD) is increasing, yet the phenotype and natural history of VEOIBD are not well described. Methods We performed a retrospective cohort study of patients diagnosed with VEOIBD (6 years of age and younger) between 2008 and 2013 at 25 North American centers. Eligible patients at each center were randomly selected for chart review. We abstracted data at diagnosis and at 1, 3, and 5 years after diagnosis. We compared the clinical features and outcomes with VEOIBD diagnosed younger than 3 years of age with children diagnosed with VEOIBD at age 3 to 6 years. Results The study population included 269 children (105 [39%] Crohn’s disease, 106 [39%] ulcerative colitis, and 58 [22%] IBD unclassified). The median age of diagnosis was 4.2 years (interquartile range 2.9–5.2). Most (94%) Crohn’s disease patients had inflammatory disease behavior (B1). Isolated colitis (L2) was the most common disease location (70% of children diagnosed younger than 3 years vs 43% of children diagnosed 3 years and older; P = 0.10). By the end of follow-up, stricturing/penetrating occurred in 7 (6.6%) children. The risk of any bowel surgery in Crohn’s disease was 3% by 1 year, 12% by 3 years, and 15% by 5 years and did not differ by age at diagnosis. Most ulcerative colitis patients had pancolitis (57% of children diagnosed younger than 3 years vs 45% of children diagnosed 3 years and older; P = 0.18). The risk of colectomy in ulcerative colitis/IBD unclassified was 0% by 1 year, 3% by 3 years, and 14% by 5 years and did not differ by age of diagnosis. Conclusions Very early onset inflammatory bowel disease has a distinct phenotype with predominantly colonic involvement and infrequent stricturing/penetrating disease. The cumulative risk of bowel surgery in children with VEOIBD was approximately 14%–15% by 5 years. These data can be used to provide anticipatory guidance in this emerging patient population.

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Metastatic Hepatocellular Carcinoma in a Patient with Crohn’s Disease Treated with Azathioprine and Infliximab: A Case Report and Literature Review

Case Reports in Gastrointestinal Medicine ◽

10.1155/2014/340836 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Kyle J. Fortinsky ◽

Ali Alali ◽

Khursheed Jeejeebhoy ◽

Sandra Fischer ◽

Morris Sherman ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Crohn’S Disease ◽

Liver Disease ◽

Crohn's Disease ◽

Case Reports ◽

Future Research ◽

Azathioprine Therapy ◽

Additional Risk ◽

Early Imaging ◽

History Of

Hepatocellular carcinoma most commonly occurs in patients with underlying liver disease or cirrhosis. We describe a case of hepatocellular carcinoma in a 34-year-old man with Crohn’s disease treated with azathioprine and infliximab. The patient had no history of liver disease and a complete autoimmune and viral workup was unremarkable. Unfortunately, the patient developed widespread metastatic disease and passed away 5 months after his initial diagnosis. The mechanism of hepatocellular carcinoma in patients’ with Crohn’s disease is poorly understood and may include both autoimmunity and treatment-related complications. Previous case reports suggest the possibility of a concerning association between azathioprine therapy and the development of hepatocellular carcinoma in patients with Crohn’s disease. Clinicians may consider early imaging in patients with Crohn’s disease presenting with concerning symptomatology or abnormal liver enzymes, especially in those being treated with azathioprine alone or in combination with infliximab. Future research may help to uncover additional risk factors for this exceedingly rare diagnosis in this patient population.

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Cytomegalovirus Infection in a Patient with Crohn’s Ileocolitis

Canadian Journal of Gastroenterology ◽

10.1155/2005/804139 ◽

2005 ◽

Vol 19 (2) ◽

pp. 109-111 ◽

Cited By ~ 2

Author(s):

Sahin Coban ◽

Arzu Ensari ◽

Mehmet Ayhan Kuzu ◽

Samet Yalcin ◽

Murat Palabiyikoglu ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Cytomegalovirus Infection ◽

Histopathological Examination ◽

Stable Condition ◽

Watery Diarrhea ◽

History Of ◽

Inflammatory Bowel

Cytomegaloviral enterocolitis is an uncommon infection that can complicate inflammatory bowel disease. A case of a patient with a three-year history of Crohn's disease is reported. He had been in a stable condition on mesalamine 4 g/day and methylprednisolone 10 mg/day for three years until four weeks before admission. The patient was admitted with complaints of fever, abdominal pain and watery diarrhea. A diagnosis of an exacerbation of Crohn's disease was established. The radiological examination revealed narrowing of the terminal ileum. Multiple fistulas and abscess-like images were observed. The patient then underwent ileocolic resection and ileostomy. The histopathological examination revealed Crohn's ileocolitis with superimposed cytomegalovirus infection. In patients with rapidly deteriorating inflammatory bowel disease, cytomegalovirus infection should be kept in mind as one of the differential diagnoses.

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