Tender thigh in a patient with Crohn′s disease (original) (raw)
Related papers
Missed presentation of Crohn's disease in a patient with a fistulating thigh abscess: a case report
Cases Journal, 2010
ABSTRACT: BACKGROUND: Musculoskeletal presentations of Crohn's disease are rare and they include psoas abscess, thigh abscesses and in extreme cases septic arthropathy. CASE PRESENTATION: Herein, we present a 53 year old gentleman with bilateral thigh fistulae discovered to be a new diagnoses of extra-intestinal Crohn's disease CONCLUSION: It is important to consider Crohn's disease in patients that present with unusual
About one fifth of cases with Crohn's disease (CD) are diagnosed in people less than 18 years. Although most of pediatric patients present with inflammatory behaviour, penetrating CD is increasingly seen. We report a case of an adolescent female, whose main complain was abdominal pain and who was diagnosed with ileal fistula and abscess. Even if surgery was initially planned, she has been treated with steroids and Sulphasalazine. She developed peritonitis and underwent ileo-cecal resection. Shortly after, an ileal fistula developed, requiring the second surgery. After the operation, she was given Sulphasalazine. In our service, she was found with active disease in the remnant ileum. She was switched to Mesalazine and Azathioprine. Currently, 13 months after starting the new therapy, she is in clinical and endoscopic remission. We emphasize the current concepts in managing fistulizing disease and preventing the post-surgical recurrence. Introduction Crohn's disease (CD) is di...
The American Journal of Medicine, 1974
of weekly clinicopathologic conferences held in the Barnes and Wohl Hospitals, are published in each issue of the Journal. These conferences are participated in jointly by members of the Departments of internal Medicine and Pathology of the Washington University School of Medicine. A 65 year old man (J.C.) was admitted to Barnes Hospital on May 16, 1973, because of diarrhea and weight loss. He died 34 days later.
Multiple abdominal abscesses complicated by severe sepsis as a result of occult Crohn’s disease
Emergency Care Journal, 2014
Intra-abdominal infections represent an important cause of mortality in worldwide population and often require both rapid diagnostic work-up and swift therapeutic decisions. In this paper a relatively frequent pathologic condition in industrialized countries is described as a potential cause of multiple abdominal abscesses with severe sepsis. In the subsequent review of the literature, first-line diagnostic examinations and therapeutic options, both medical and surgical, are discussed according to the most recent guidelines and recommendations.
Meningitis in a Patient with Previously Undiagnosed Crohnʼs Disease
Inflammatory Bowel Diseases, 2009
To the Editor: Crohn's disease (CD) is a chronic inflammatory bowel disease with variable clinical presentation. An aggressive fistulizing pattern is possible and over one-third of CD patients will experience recurring fistulas during their disease course. 1 Fistulization is a manifestation of the transmural nature of this disease, 2 but fistulas to the epidural space are quite unusual. 3 Herein we report a case of a male patient who presented to the medical emergency department with meningitis. Physical examination revealed multiple perianal and an abdominal fistula and subsequent complementary studies confirmed the presence of CD. A 26-year-old man was admitted to the emergency room because of high fever, severe headache, acute confusion, nausea, and vomiting. On admission his body temperature was 39°C, heart rate 120, respiratory rate 16, and blood pressure 103/55 mmHg. On physical examination the patient was confused, not oriented to person, place, or time. Kerning and Brudzinski signs were present but no Babinski or clonus. Ophthalmologic examination revealed papilloedema. There was no otitis, pharyngitis, or sinusitis and heart/lung examination was normal. Abdominal and pelvic examination revealed a large abdominal cutaneous fistula in the lower right quadrant and multiple perianal fistulas. Laboratory results upon admission showed leukocytosis (WBC of 23.2 G/L with 92% of PMN), thrombocytosis
Clinical Challenges: 18 Year Old Male with Bloody Diarrhea
The Journal of Pediatrics, 2005
An 18-year-old boy presented to the emergency department with a 2-week history of diarrhea and fatigue. His diarrhea was watery and nonbloody, occurring several times a day. A diagnosis of viral gastroenteritis had been made by his primary care physician. Four days before admission, his diarrhea became more frequent, accompanied by nonbloody, nonbilious emesis, and worsening fatigue. His parents noted that he looked pale and had low-grade temperatures. He denied night-time stooling but admitted to having 1 episode of fecal incontinence. He denied abdominal pain, night sweats, weight loss, jaundice, rash, easy bruising, or bleeding. There was no recent travel or unusual exposures. Medical history was notable for psoriasis. Family history was negative for inflammatory bowel disease or celiac disease but was positive for a maternal grandfather with a ''ruptured colon.'' There was no family history of bleeding or clotting disorders. Physical examination revealed a pale, well-grown boy in no distress. He was fever free, with tachycardia to 119 beats/min and hypertension with a blood pressure of 148/72 mm Hg, and he had a normal respiratory rate. His weight plotted to the 90th percentile and height plotted to the 75th percentile for age. Head, ears, eyes, nose, and throat examination showed no scleral icterus but revealed an ulcer on the left tonsil. Cardiac examination revealed a I/VI systolic murmur along the left sternal border. His abdomen was not distended and not tender with no hepatomegaly; however, a spleen tip was palpable. A rectal examination revealed gross blood with no fissures or tags. On skin examination, there were no bruises, petechiae, or rashes. The patient was admitted to the hospital for further evaluation. While hospitalized his diarrhea became grossly bloody with mucus. Initial laboratory results included a white blood cell count of 22,300 cells/mm 3 with a differential of 44% neutrophils, 36% bands, 9% lymphocytes, 7% monocytes, 1% eosinophils, 1% metamyelocytes, and 2 % myelocytes. Hemoglobin was 8.3 g/dL, hematocrit 25.8 %, with a low mean corpuscular volume of 63 and elevated red cell volume distribution width of 19.4%. Platelet count was 38,000/mm 3. The reticulocyte count was 4.5 %. The peripheral smear revealed red blood cell fragments, ovalocytes, teardrop cells, and hypochromia. Blood urea nitrogen level was 13 mg/dL, and creatinine was 1.5 mg/dL. Liver function tests revealed elevated alanine aminotransferase of 1030 IU/L, aspartate aminotransferase of 746 IU/L, alkaline phosphatase of 133 IU/L, gamma-glutamyltransferase of 73 IU/L, total bilirubin of 0.4 mg/dL, and albumin of 2.9 g/dL. The prothrombin time was elevated at 19.8 seconds, with an activated partial thromboplastin time of 29.4 seconds, and an elevated international normalized ratio of 1.8. The lactate dehydrogenase was 1118 IU/L, and uric acid was 8.8 mg/dL. Erythrocyte sedimentation rate was 24 mm/h. Urinalysis revealed 2 red blood cells, trace ketones, small amount of protein, and 26 hyaline casts. Evaluation for infectious enteritis with stool cultures, ova, and parasites, and Clostridium difficile toxin proved negative. Blood cultures were negative. Tests for infectious hepatitis including a hepatitis panel and cytomegalovirus antigen were negative. Epstein-Barr virus titers were consistent with a remote prior infection. Serial complete blood count and liver function tests revealed that the low platelet count and elevated transaminases returned toward normal levels. Renal function remained normal throughout the admission. An opthalmologic examination was negative for Kayser-Fleischer rings, and serum ceruloplasmin and copper levels, as well as 24-hour urinary copper levels, were within normal limits. Abdominal ultrasonography with Doppler scanning revealed no flow in the left portal vein, but patent and normal flow direction in the right portal, main portal, and splenic veins. There was a mildly enlarged spleen, nonspecific gallbladder wall thickening, and a moderate amount of free fluid within the abdomen. The kidneys and liver were otherwise normal. Because there was evidence of possible thrombosis in the portal vein by ultrasound examination, initial therapy with vitamin K was discontinued, and fresh frozen plasma was not administered.
A Common Disease With an Unusual Complication of Acute Abdomen
Gastroenterology, 2012
Question: A previously healthy 64-year-old man presented to the emergency department with a 4-day duration of progressive and diffuse abdominal pain. The pain, seemingly unrelated to meals or postural change, began with intermittent cramps and progressed to a steady, constant ache. Physical examination revealed marked lower quadrant tenderness, diffuse peritoneal sign, and reduced bowel sounds. Deep tenderness at McBurney's point was not obvious. Laboratory investigation disclosed leukocytosis with a left shift, and the remaining tests were unremarkable. Contrast-enhanced computed tomography (CT) was performed (Figure A). What is your diagnosis and management? See the GASTROENTEROLOGY web site (www.gastrojournal .org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.