JPGN Journal of Pediatric Gastroenterology and Nutrition Publish Ahead of Print DOI : 10.1097/MPG.0000000000000731
Unusual Ulcerations in Crohn’s Disease
David I. Ward, MD1 and Elizabeth M. McDonough, MD2 1
Department of Pediatrics, University of Arkansas for Medical Sciences, 2 Division of
Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Arkansas for Medical Sciences
Correspondence: Elizabeth McDonough 1 Children’s Way, Slot 512-7 Little Rock, AR 72202 Fax: 501-364-6291 Phone: 501-364-1004 [email protected]
No funding sources or conflict of interest for either author. This manuscript has not been published in any other journal or language.
Word count: 198 Images: 2
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.
David I. Ward and Elizabeth M. McDonough
A 15-year-old healthy male presented with 2 weeks of abdominal pain, vomiting, diarrhea and fever. Family history was negative for inflammatory bowel disease and other autoimmune diseases. Labs showed a mild anemia, hypoalbuminemia, and increased C-reactive protein. Stool infectious studies were negative and CT showed pancolitis. Colonoscopy revealed sparing of the rectum. In the sigmoid colon, small ulcers appeared and increased in size and depth up to the transverse colon and almost appeared to be diverticula (Image 1). Histopathology showed active colitis with several granulomas and a predominantly plasmacytic infiltrate. Immunohistochemistry, serology and cultures were negative for all organisms, including mycobacteria, histoplasmosis, cytomegalovirus, syphilis, and Entamoeba histolytica. He improved spontaneously over ten days. He returned to clinic two weeks later with 10 kilogram weight loss, diarrhea and fevers. Lab studies revealed worsening anemia, hypoalbuminemia and C-reactive protein. Repeat colonoscopy showed some improvement of ulcerations and colitis from sigmoid to transverse
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
colon. Histopathology revealed continued acute colitis but now with chronicity. He subsequently improved on infliximab.
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
Image 1 1: initial colo onoscopy
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
Unusual Ulcerations in Crohn’s Disease
David I. Ward, MD1 and Elizabeth M. McDonough, MD2 1
Department of Pediatrics, University of Arkansas for Medical Sciences, 2 Division of
Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Arkansas for Medical Sciences
Correspondence: Elizabeth McDonough 1 Children’s Way, Slot 512-7 Little Rock, AR 72202 Fax: 501-364-6291 Phone: 501-364-1004 [email protected]
No funding sources or conflict of interest for either author. This manuscript has not been published in any other journal or language.
Word count: 198 Images: 2
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.
David I. Ward and Elizabeth M. McDonough
A 15-year-old healthy male presented with 2 weeks of abdominal pain, vomiting, diarrhea and fever. Family history was negative for inflammatory bowel disease and other autoimmune diseases. Labs showed a mild anemia, hypoalbuminemia, and increased C-reactive protein. Stool infectious studies were negative and CT showed pancolitis. Colonoscopy revealed sparing of the rectum. In the sigmoid colon, small ulcers appeared and increased in size and depth up to the transverse colon and almost appeared to be diverticula (Image 1). Histopathology showed active colitis with several granulomas and a predominantly plasmacytic infiltrate. Immunohistochemistry, serology and cultures were negative for all organisms, including mycobacteria, histoplasmosis, cytomegalovirus, syphilis, and Entamoeba histolytica. He improved spontaneously over ten days. He returned to clinic two weeks later with 10 kilogram weight loss, diarrhea and fevers. Lab studies revealed worsening anemia, hypoalbuminemia and C-reactive protein. Repeat colonoscopy showed some improvement of ulcerations and colitis from sigmoid to transverse
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
colon. Histopathology revealed continued acute colitis but now with chronicity. He subsequently improved on infliximab.
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
Image 1 1: initial colo onoscopy
Copyright © ESPGHAN and NASPGHAN. All rights reserved.
