An Adolescent Girl with an Extraordinary Crohn Disease

Inflammatory bowel disease (IBD) is a comprehensive term used to describe diseases of the gastrointestinal tract resulting from chronic inflammatory processes. Patients with Crohn`s disease, a type of IBD, also may have extraintestinal findings. Joint symptoms and mucocutaneous involvement are the most common manifestations. Therefore, the presence of symptoms such as swollen, painful joints, aphthous stomatitis, erythema nodosum, uveitis, and pericarditis should not be avoided.

A 15-year-old girl was admitted to our outpatient clinic with complaints of severe abdominal pain, nausea, vomiting and bleeding in one eye. The patient was diagnosed with acute pancreatitis and uveitis at the first evaluation, followed by bloody diarrhea and arthritis. In endoscopy, antrum, bulbus and second segment of duodenum were seen as hyperemic, nodular and edematous. In the colonoscopy, mucosa of the terminal ileum was granular and edematous. The cecum, the ascending colon, hepatic flexure, descending colon, sigmoid colon, and rectum mucosa were hyperemic, granular in appearance (cobblestone view) and lymphoid hyperplasic in appearance. The patient was diagnosed as multisystemic Crohn`s disease. The patient was followed up with prednisolone and mesalazine treatment. At the end of one-year follow-up, the symptoms of pancreatitis improved totally, but there were no response to the treatment for uveitis and arthritis, and patient developed pericarditis and bloody diarrhea continued occasionally. Infliximab, a biological agent (tumour necrotising factor alpha, TNFa blocker), was the second choice of treatment. The expected result could not be obtained and after 6 cure treatments medication was switched to adalimumab. After 6 cycles of treatment, the patient`s symptoms were completely regressed.

In conclusion, it should be kept in mind that extraintestinal manifestations of IBD can occur in pediatric patients before the original signs of the disease occur. The management of these findings with new treatment modalities may result in more positive outcomes in the future.