Slideshow: Presentations of Inflammatory Bowel Diseases

Welcome to our latest slideshow! Click through the slides to learn about different presentations of inflammatory bowel diseases, including ulcerative colitis and Crohn disease. Each slide links to the full case report for more details.

A 29-year-old man presented with worsening of pain and swelling in the posterior aspect of the right thigh, which had been associated with subjective fever 2 days prior to presentation.

He had 15-year history of autoimmune hepatitis that had been well controlled with immunosuppressive agents 6-MP, sirolimus, and budesonide. His overall health status had been uneventful until 1 week after starting mesalamine therapy for recently diagnosed ulcerative colitis, which had been confirmed by colonoscopy and biopsy.

Esophagogastroduodenoscopy showed mild gastritis and a single smooth nodule measuring 5 to 6 mm in the antrum (Figure).

Read the full case report here.

A previously healthy 9-year-old girl presented to the emergency department for evaluation of fever, unilateral ankle pain and swelling, and an inability to bear weight.

Endoscopy was performed and showed esophageal ulcerations and a severely inflamed colon with pseudopolyps, erythema, exudate, and ulcerations throughout (Figure). Pathology test results showed chronic active ileitis and colitis and granulomatous inflammation, consistent with a diagnosis of Crohn disease.

Read the full case report here.

A 31-year-old previously healthy woman was admitted to the hospital for a 5-day history of bloody diarrhea and associated epigastric abdominal pain. She reported having a fever, with a maximum temperature of 38.3°C. She had nausea but no vomiting. Her medical history was notable only for major depressive disorder and seasonal allergies. She had no recent history of travel and no known sick contacts. She worked as a school counselor. She did not use tobacco or recreational drugs.

Computed tomography scans of the abdomen and pelvis showed moderate to severe diffuse colonic wall thickening and adjacent inflammatory stranding (Figure), compatible with acute colitis involving the entirety of the colon.

Read the full case report here.

A previously healthy 7-year-old boy presented after 3 weeks of recurrent fevers, left lower-extremity pain, and mild diarrhea. In the emergency department (ED), he reported decreased appetite and energy levels but denied weight loss. There was no history of rashes, nausea, vomiting, or night sweats.

Biopsy revealed mild to severe esophagitis, gastritis, and duodenitis, as well as findings consistent with Crohn ileocolitis (Figure). 

Read the full case report here.

A 60-year-old man presented to the emergency department with abdominal pain, mild rectal bleeding, tenesmus, and frequent liquid mucous stools for 18 days, reporting “loose stools” in the morning and several “explosive, watery stools” in the afternoon.

Inpatient colonoscopy was performed, during which erythema congestion and ulceration in the rectum, sigmoid colon, and descending colon were found (Figure). Biopsies were taken. On histological examination, the rectal, sigmoid, and descending colon mucosa showed mucosal hyperplasia with crypt abscess and evidence of acute and chronic inflammation. A diagnosis of ulcerative colitis was made.

Read the full case report here.

An 11-year-old girl presented to the emergency department with a 2-week history of nausea and vomiting in the context of chronic abdominal pain, diarrhea, and unintentional weight loss. Her parents reported that the girl had experienced one to two episodes of postprandial abdominal pain and vomiting multiple times a week, as well as three to four loose, nonbloody stools per day. She had lost 9 kg over the previous year, and an earlier workup by her primary care provider had been notable for anemia (hemoglobin, 7.6 g/dL) and heme-positive stools.

A complete blood cell count showed a persistent moderate microcytic anemia with no leukocytosis or thrombocytosis. The sedimentation rate was elevated at 64 mm/h. Out of concern for new-onset inflammatory bowel disease, she was admitted. Given the history of vomiting and concern for stricture, an upper gastrointestinal contrast study was obtained, the results of which were notable a large filling defect extending from the stomach through the pylorus to the proximal jejunum, with features suggestive of a large trichobezoar (Figure).

Read the full case report here.

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