Slideshow: Presentations of Inflammatory Bowel Disease

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    In this slideshow, click through different presentations of inflammatory bowel disease, including cases of ulcerative colitis and Crohn disease. Each slide includes a link to the full case report for more information.

  • Concurrent Autoimmune Hepatitis and Ulcerative Colitis With Pancytopenia

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    A 29-year-old man presented with worsening of pain and swelling in the posterior aspect of the right thigh, which had been associated with subjective fever 2 days prior to presentation.

    He had 15-year history of autoimmune hepatitis (AIH) that had been well controlled with immunosuppressive agents 6-MP, sirolimus, and budesonide. His overall health status had been uneventful until 1 week after starting mesalamine therapy for recently diagnosed ulcerative colitis (UC), which had been confirmed by colonoscopy and biopsy.

    Read the full case report here. 

  • Inflammatory Bowel Disease Presenting as Recurrent Aphthous Ulcers in a 10-Year-Old Boy

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    A 10-year-old boy presented with his parents to the pediatric primary care clinic with multiple long-lasting, recurrent oral ulcers and periumbilical abdominal pain after meals several times a week.

    The 4 oral ulcerations were first noticed 3½ weeks prior to the clinic visit. He has had oral ulcerations in the past that have occurred since approximately age 3 years. These were evaluated by a dentist and his prior primary care provider, who had diagnosed aphthous ulcers. However, the more recent ulcerations seemed deeper and lasted longer (multiple weeks) compared with the patient’s prior ulcerations. 

    Read the full case report here. 

  • Inflammatory Bowel Disease Presenting as a Rash

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    A 13-year-old girl with a history of constipation and anemia presented with abdominal pain and a new rash. She and her mother reported that the girl had had daily, intermittent episodes of epigastric and lower abdominal cramping that had often been followed by watery, nonbloody, nonmucoid diarrhea over the past 2 months.

    Her pain was not associated with any particular food or with eating. The pain was not severe and did not radiate. She took no medications to alleviate it.

    Read the full case report here. 

  • New-Onset Ulcerative Colitis After Kidney Transplant Immunosuppression

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    A 60-year-old man presented to the emergency department with abdominal pain, mild rectal bleeding, tenesmus, and frequent liquid mucous stools for 18 days, reporting “loose stools” in the morning and several “explosive, watery stools” in the afternoon.

    The man had a history of Alport syndrome for which he had undergone kidney transplant 12 years ago and for which he was taking tacrolimus and mycophenolic acid. He denied any gross blood in the stool, but guaiac fecal occult blood test results were positive, and he reported a 1.8-kg weight loss during his diarrheal illness. He had not undergone colonoscopy, and he reported no family history of inflammatory bowel disease (IBD).

    Read the full case report here. 

  • Extraintestinal Manifestations of Crohn Disease Mimicking Septic Arthritis

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    A previously healthy 9-year-old girl presented to the emergency department (ED) for evaluation of fever, unilateral ankle pain and swelling, and an inability to bear weight.

    Initially laboratory test results were significant for a white blood cell count of 6900/µL, a hemoglobin level of 10.9 g/dL, a platelet count of 552 × 103/µL, an erythrocyte sedimentation rate of 96 mm/h, and C-reactive protein level of 12.7 mg/dL. She was evaluated by the orthopedics team in the ED and admitted for further evaluation with magnetic resonance imaging (MRI) out of concern for septic arthritis. 

    Read the full case report here.