Clinical case of atypical course of Crohn’s disease

Authors

DOI:

https://doi.org/10.14739/2310-1237.2022.3.245620

Keywords:

Crohn’s disease, inflammatory bowel diseases, atypical course, extraintestinal manifestations, polyneuropathies, vasculitis, perforation

Abstract

Crohn’s disease (CD) is a chronic recurrent inflammatory bowel disease with a wide variety of clinical manifestations – from classical gastrointestinal phenotypes to predominance of extraintestinal symptoms. Atypical course of CD is observed relatively often and is manifested with a damage to almost all body systems, including hepatobiliary, immune, hematopoietic, cardiovascular, nervous, as well as eyes, skin, lungs and kidneys. Atypical manifestation often precedes intestinal, making diagnosis difficult. The presence of various clinical manifestations of CD, often an atypical course, as well as the absence of standardized diagnostic criteria can be an obstacle for physicians in the timely detection of the disease and effective treatment.

Aim: to describe a clinical case of a diagnostically difficult patient of our clinic with an atypical course of CD and complications incompatible with life; highlight the problem of monitoring and possible solutions.

Results. In the presented clinical case the patient with an atypical course of CD, with the prevailing displays of defeat of nervous and vascular systems is described. During hospitalization, a full range of diagnostic tests was performed, consultations with related specialists were obtained, but no direct data of inflammatory bowel disease were found. At the same time, the impossibility of performing a colonoscopy with a biopsy, due to the severity of the patient’s condition, delayed the timely diagnosis of CD and contributed to the development of complications incompatible with life.

The diagnosis was made posthumously. The patient died as a result of intoxication due to the development of complications of CD – perforation of the intestine, intestinal abscess, development of peritonitis, septicemia.

Conclusions. In the described clinical case CD is considered as a complex interdisciplinary problem, and emphasizes the importance of doctor’s awareness of the variants of atypical manifestations and course of inflammatory bowel disease, methods for their assessment and ways of effective management. This case also presents the latest epidemiological data on the prevalence of atypical manifestations of CD, identifies key areas of diagnostic search in case of a difficult patient.

 

Author Biographies

L. V. Zhuravlyova, Kharkiv National Medical University, Kharkiv, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Internal Medicine №3 and Endocrinology

Yu. K. Sikalo, Kharkiv National Medical University, Kharkiv, Ukraine

MD, PhD, Associate Professor of the Department of Internal Medicine 3 and Endocrinology

M. O. Oliinyk, Kharkiv National Medical University, Kharkiv, Ukraine

MD, PhD, Associate Professor of the Department of Internal Medicine 3 and Endocrinology

A. K. Zhuravlyova, Kharkiv National Medical University, Kharkiv, Ukraine

PhD, Associate Professor, Department of General Practice - Family Medicine and Internal Medicine

H. P. Zinchenko, Communal Non-Profit Enterprise of the Kharkiv Regional Council “Regional Clinical Hospital”, Ukraine

MD, Doctor-Rheumatologist of the Rheumatology Department

Ye. V. Tytov, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine

MD, PhD, Pathologist of the Highest Category, Assistant of the

References

Nebyltsova, O. V., Klimova, Zh. A., Nosenko, G. A., Boiko, I. V., Klishnya, M. A., Chernyshova, L. A., Solomko, N. A., Malikova, S. V., Danilova, I. E., Abasheva, S. N., Malinovskaya G. A., Dontsova, O. V., Borovik, O. A., Yakovenko, O., Dmitrenko, O. V., & Polushina, T. M. (2013). Laboratornyi spravochnik SINEVO [Laboratory directory SINEVO]. Ltd. "Doctor Media." [in Russian].

Stepanov Yu. M., Skyrda I. Yu., & Petishko O. P. (2017). Khronichni zapalni zakhvoriuvannia kyshechnyka: osoblyvosti epidemiolohii v Ukraini [Chronic inflammatory bowel diseases: epidemiological features in Ukraine]. Gastroenterology, 51(2), 97-105. [in Ukrainian]. https://doi.org/10.22141/2308-2097.51.2.2017.101703

Antonelli, E., Bassotti, G., Tramontana, M., Hansel, K., Stingeni, L., Ardizzone, S., Genovese, G., Marzano, A. V., & Maconi, G. (2021). Dermatological Manifestations in Inflammatory Bowel Diseases. Journal of clinical medicine, 10(2), 364. https://doi.org/10.3390/jcm10020364

Benavente, L., & Morís, G. (2011). Neurologic disorders associated with inflammatory bowel disease. European journal of neurology, 18(1), 138-143. https://doi.org/10.1111/j.1468-1331.2010.03095.x

Burisch, J., Pedersen, N., Čuković-Čavka, S., Brinar, M., Kaimakliotis, I., Duricova, D., Shonová, O., Vind, I., Avnstrøm, S., Thorsgaard, N., Andersen, V., Krabbe, S., Dahlerup, J. F., Salupere, R., Nielsen, K. R., Olsen, J., Manninen, P., Collin, P., Tsianos, E. V., Katsanos, K. H., … EpiCom-group (2014). East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut, 63(4), 588-597. https://doi.org/10.1136/gutjnl-2013-304636

Garber, A., & Regueiro, M. (2019). Extraintestinal Manifestations of Inflammatory Bowel Disease: Epidemiology, Etiopathogenesis, and Management. Current gastroenterology reports, 21(7), 31. https://doi.org/10.1007/s11894-019-0698-1

Harbord, M., Annese, V., Vavricka, S. R., Allez, M., Barreiro-de Acosta, M., Boberg, K. M., Burisch, J., De Vos, M., De Vries, A. M., Dick, A. D., Juillerat, P., Karlsen, T. H., Koutroubakis, I., Lakatos, P. L., Orchard, T., Papay, P., Raine, T., Reinshagen, M., Thaci, D., Tilg, H., … European Crohn’s and Colitis Organisation (2016). The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease. Journal of Crohn's & colitis, 10(3), 239-254. https://doi.org/10.1093/ecco-jcc/jjv213

Hatemi, I., Hatemi, G., & Çelik, A. F. (2017). Systemic vasculitis and the gut. Current opinion in rheumatology, 29(1), 33-38. https://doi.org/10.1097/BOR.0000000000000344

Huang, B. L., Chandra, S., & Shih, D. Q. (2012). Skin manifestations of inflammatory bowel disease. Frontiers in physiology, 3, 13. https://doi.org/10.3389/fphys.2012.00013

Kim, S., Kang, S. J., Oh, K. W., Ahn, B. K., Lee, H. L., Han, D. S., Jang, K., & Kim, Y. S. (2015). Chronic inflammatory demyelinating polyneuropathy-like neuropathy as an initial presentation of Crohn's disease. BMC neurology, 15, 48. https://doi.org/10.1186/s12883-015-0302-8

Malik, T. F., & Aurelio, D. M. (2022). Extraintestinal Manifestations of Inflammatory Bowel Disease. In StatPearls. StatPearls Publishing.

Papay, P., Miehsler, W., Tilg, H., Petritsch, W., Reinisch, W., Mayer, A., Haas, T., Kaser, A., Feichtenschlager, T., Fuchssteiner, H., Knoflach, P., Vogelsang, H., Platzer, R., Tillinger, W., Jaritz, B., Schmid, A., Blaha, B., Dejaco, C., Sobala, A., Weltermann, A., … Novacek, G. (2013). Clinical presentation of venous thromboembolism in inflammatory bowel disease. Journal of Crohn's & colitis, 7(9), 723-729. https://doi.org/10.1016/j.crohns.2012.10.008

Roth, N., Biedermann, L., Fournier, N., Butter, M., Vavricka, S. R., Navarini, A. A., Rogler, G., Scharl, M., & Swiss IBD Cohort Study Group (2019). Occurrence of skin manifestations in patients of the Swiss Inflammatory Bowel Disease Cohort Study. PloS one, 14(1), e0210436. https://doi.org/10.1371/journal.pone.0210436

Stadnicki, A., & Stadnicka, I. (2021). Venous and arterial thromboembolism in patients with inflammatory bowel diseases. World journal of gastroenterology, 27(40), 6757-6774. https://doi.org/10.3748/wjg.v27.i40.6757

Sy, A., Khalidi, N., Dehghan, N., Barra, L., Carette, S., Cuthbertson, D., Hoffman, G. S., Koening, C. L., Langford, C. A., McAlear, C., Moreland, L., Monach, P. A., Seo, P., Specks, U., Sreih, A., Ytterberg, S. R., Van Assche, G., Merkel, P. A., Pagnoux, C., Vasculitis Clinical Research Consortium (VCRC), … Canadian Vasculitis Network (CanVasc) (2016). Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature. Seminars in arthritis and rheumatism, 45(4), 475-482. https://doi.org/10.1016/j.semarthrit.2015.07.006

Vavricka, S. R., Rogler, G., Gantenbein, C., Spoerri, M., Prinz Vavricka, M., Navarini, A. A., French, L. E., Safroneeva, E., Fournier, N., Straumann, A., Froehlich, F., Fried, M., Michetti, P., Seibold, F., Lakatos, P. L., Peyrin-Biroulet, L., & Schoepfer, A. M. (2015). Chronological Order of Appearance of Extraintestinal Manifestations Relative to the Time of IBD Diagnosis in the Swiss Inflammatory Bowel Disease Cohort. Inflammatory bowel diseases, 21(8), 1794-1800. https://doi.org/10.1097/MIB.0000000000000429

Vavricka, S. R., Schoepfer, A., Scharl, M., Lakatos, P. L., Navarini, A., & Rogler, G. (2015). Extraintestinal Manifestations of Inflammatory Bowel Disease. Inflammatory bowel diseases, 21(8), 1982-1992. https://doi.org/10.1097/MIB.0000000000000392

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Published

2023-01-27

How to Cite

1.
Zhuravlyova LV, Sikalo YK, Oliinyk MO, Zhuravlyova AK, Zinchenko HP, Tytov YV. Clinical case of atypical course of Crohn’s disease. Pathologia [Internet]. 2023Jan.27 [cited 2024May2];19(3):256-62. Available from: http://pat.zsmu.edu.ua/article/view/245620

Issue

Vol. 19 No. 3 (2022)

Section

Case Reports

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