Clinical case of atypical course of Crohn’s disease

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.

Keywords

• crohn’s disease
• inflammatory bowel diseases
• atypical course
• extraintestinal manifestations
• polyneuropathies
• vasculitis
• perforation