A Challenging Case of Oral Ulcers and Gastrointestinal Bleeding: Crohn’s or Behçet’s Disease
Introduction. Differentiating Crohn’s disease (CD) and Behçet’s disease (BD) with gastrointestinal (GI) manifestations can be clinically challenging, as current diagnostic criteria are not clear between both conditions and multiple symptoms could overlap. Case Presentation. The patient is an 8-year-...
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| Language: | English |
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Wiley
2023-01-01
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| Series: | Case Reports in Pediatrics |
| Online Access: | http://dx.doi.org/10.1155/2023/4705638 |
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| author | Marina A. S. Dantas Ana Luiza Graneiro Rodrigo Cavalcante Lina Maria Felipez |
| author_facet | Marina A. S. Dantas Ana Luiza Graneiro Rodrigo Cavalcante Lina Maria Felipez |
| author_sort | Marina A. S. Dantas |
| collection | DOAJ |
| description | Introduction. Differentiating Crohn’s disease (CD) and Behçet’s disease (BD) with gastrointestinal (GI) manifestations can be clinically challenging, as current diagnostic criteria are not clear between both conditions and multiple symptoms could overlap. Case Presentation. The patient is an 8-year-old boy of Brazilian descent, who initially presented with a 1-year history of painful oral ulcers. Before presenting to the hospital, he had been treated for periodic fever, aphthous stomatitis, pharyngitis, and adenitis and placed on steroids, with relapsing symptoms on attempts to wean the doses. The initial workup was largely unremarkable. Buccal biopsies showed no granulomas, and the ophthalmologic exam was normal. Infectious and rheumatological tests were negative. Prometheus IBD sgi testing showed a pattern consistent with CD; however, the patient had multiple negative endoscopies, colonoscopies, and capsule endoscopies. He developed intermittent bloody stools and severe malnutrition and did not respond to infliximab, colchicine, or methotrexate. After a large GI bleed, a 4th colonoscopy was performed, which showed large round ulcers in the terminal ileum, and no granulomas. He was started on ustekinumab with clinical improvement. One month later, he developed bilateral hip effusion and meningismus, being diagnosed with aseptic meningitis secondary to COVID-19. He improved, but in one month developed worsening symptoms, and MRV showed extensive venous sinus thrombosis. The patient was started on enoxaparin, methylprednisolone, and colchicine, with resolution of the thrombus on a 3-month follow-up. The patient’s overall symptoms remained controlled with clinical and biochemical remission on monthly ustekinumab. Discussion and Conclusion. Our patient had a challenging clinical course, with nonspecific systemic and intestinal manifestations which proved difficult to differentiate between BD and CD. Given endoscopic findings and the worsening of an auto-inflammatory reaction in the central nervous system after COVID-19 in a patient with controlled GI symptoms, the most likely diagnosis is BD. |
| format | Article |
| id | doaj-art-b114380141a4418eb664337878a046d1 |
| institution | Kabale University |
| issn | 2090-6811 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Pediatrics |
| spelling | doaj-art-b114380141a4418eb664337878a046d12025-02-03T01:29:41ZengWileyCase Reports in Pediatrics2090-68112023-01-01202310.1155/2023/4705638A Challenging Case of Oral Ulcers and Gastrointestinal Bleeding: Crohn’s or Behçet’s DiseaseMarina A. S. Dantas0Ana Luiza Graneiro1Rodrigo Cavalcante2Lina Maria Felipez3Department of Pediatric Hospital MedicineDepartment of Allergy and ImmunologyDepartment of CardiologyDepartment of GastroenterologyIntroduction. Differentiating Crohn’s disease (CD) and Behçet’s disease (BD) with gastrointestinal (GI) manifestations can be clinically challenging, as current diagnostic criteria are not clear between both conditions and multiple symptoms could overlap. Case Presentation. The patient is an 8-year-old boy of Brazilian descent, who initially presented with a 1-year history of painful oral ulcers. Before presenting to the hospital, he had been treated for periodic fever, aphthous stomatitis, pharyngitis, and adenitis and placed on steroids, with relapsing symptoms on attempts to wean the doses. The initial workup was largely unremarkable. Buccal biopsies showed no granulomas, and the ophthalmologic exam was normal. Infectious and rheumatological tests were negative. Prometheus IBD sgi testing showed a pattern consistent with CD; however, the patient had multiple negative endoscopies, colonoscopies, and capsule endoscopies. He developed intermittent bloody stools and severe malnutrition and did not respond to infliximab, colchicine, or methotrexate. After a large GI bleed, a 4th colonoscopy was performed, which showed large round ulcers in the terminal ileum, and no granulomas. He was started on ustekinumab with clinical improvement. One month later, he developed bilateral hip effusion and meningismus, being diagnosed with aseptic meningitis secondary to COVID-19. He improved, but in one month developed worsening symptoms, and MRV showed extensive venous sinus thrombosis. The patient was started on enoxaparin, methylprednisolone, and colchicine, with resolution of the thrombus on a 3-month follow-up. The patient’s overall symptoms remained controlled with clinical and biochemical remission on monthly ustekinumab. Discussion and Conclusion. Our patient had a challenging clinical course, with nonspecific systemic and intestinal manifestations which proved difficult to differentiate between BD and CD. Given endoscopic findings and the worsening of an auto-inflammatory reaction in the central nervous system after COVID-19 in a patient with controlled GI symptoms, the most likely diagnosis is BD.http://dx.doi.org/10.1155/2023/4705638 |
| spellingShingle | Marina A. S. Dantas Ana Luiza Graneiro Rodrigo Cavalcante Lina Maria Felipez A Challenging Case of Oral Ulcers and Gastrointestinal Bleeding: Crohn’s or Behçet’s Disease Case Reports in Pediatrics |
| title | A Challenging Case of Oral Ulcers and Gastrointestinal Bleeding: Crohn’s or Behçet’s Disease |
| title_full | A Challenging Case of Oral Ulcers and Gastrointestinal Bleeding: Crohn’s or Behçet’s Disease |
| title_fullStr | A Challenging Case of Oral Ulcers and Gastrointestinal Bleeding: Crohn’s or Behçet’s Disease |
| title_full_unstemmed | A Challenging Case of Oral Ulcers and Gastrointestinal Bleeding: Crohn’s or Behçet’s Disease |
| title_short | A Challenging Case of Oral Ulcers and Gastrointestinal Bleeding: Crohn’s or Behçet’s Disease |
| title_sort | challenging case of oral ulcers and gastrointestinal bleeding crohn s or behcet s disease |
| url | http://dx.doi.org/10.1155/2023/4705638 |
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