Introduction: Crohn’s Disease (CD) is a chronic inflammatory disorder with a heterogeneous presentation. While diarrhea, abdominal pain, and weight loss are hallmarks, atypical manifestations can obscure the diagnosis. This report highlights an unusual presentation of CD to emphasize the need for comprehensive diagnostic strategies. Case Report: A 25-year-old male presented with peripheral edema, anorexia, and abdominal distension but lacked classic gastrointestinal (GI) symptoms. Laboratory findings included microcytic anemia and hypoalbuminemia, while imaging revealed ascites and bowel wall thickening. Elevated fecal calprotectin and positive Anti-Saccharomyces cerevisiae antibodies (ASCA) supported the diagnosis. Endoscopy confirmed ileocolic Crohn’s Disease (L3 + L4). Infliximab therapy resulted in marked clinical improvement. Discussion: This case underscores the complexity of atypical CD presentations. Early use of serological markers, imaging, and endoscopy guided the diagnosis. Recognition of CD’s diverse manifestations is critical for timely intervention. Conclusion: Atypical CD presentations require heightened clinical suspicion and a multidisciplinary approach to reduce diagnostic delays and improve patient outcomes.
References
[1]
Baumgart, D.C. and Sandborn, W.J. (2019) Crohn’s Disease. The Lancet, 393, 1932-1945.
[2]
Torres, J., Mehandru, S., Colombel, J. and Peyrin-Biroulet, L. (2017) Crohn’s Disease. The Lancet, 389, 1741-1755. https://doi.org/10.1016/s0140-6736(16)31711-1
[3]
Ng, S.C., et al. (2020) Worldwide Incidence and Prevalence of Inflammatory Bowel Disease in the 21st Century: A Systematic Review. Lancet Gastroenterology & Hepatology, 5, 17-30.
[4]
Colombel, J.F., Sandborn, W.J., Reinisch, W., Mantzaris, G.J., Kornbluth, A., Rachmilewitz, D., et al. (2010) Infliximab, Azathioprine, or Combination Therapy for Crohn’s Disease. New England Journal of Medicine, 362, 1383-1395. https://doi.org/10.1056/nejmoa0904492
[5]
Vermeire, S., et al. (2021) Recent Insights into the Pathophysiology of Inflammatory Bowel Diseases. Gastroenterology, 161, 55-70.
[6]
Lewis, J.D. (2011) The Utility of Biomarkers in the Diagnosis and Therapy of Inflammatory Bowel Disease. Gastroenterology, 140, 1817-1826.e2. https://doi.org/10.1053/j.gastro.2010.11.058
[7]
Feuerstein, J.D., et al. (2021) AGA Clinical Practice Guidelines on the Management of Crohn’s Disease. Gastroenterology, 160, 2317-2351.
[8]
Colombel, J.F., et al. (2020) Advances in the Treatment of Crohn’s Disease: 2020 Update. Nature Reviews Gastroenterology & Hepatology, 17, 707-725.
[9]
Torres, J., et al. (2020) Endoscopic Healing in Crohn’s Disease: Predictors and Implications for Long-Term Outcomes. The Lancet Gastroenterology & Hepatology, 5, 398-408.
[10]
Sands, B.E., et al. (2020) Predictive Biomarkers for Response to Anti-TNF Therapy in Inflammatory Bowel Disease. Gastroenterology, 158, 303-317.
