R ecurrent perianal abscesses and fistulas heighten suspicion for Crohn disease (CD). Perianal disease often occurs in association with gastrointestinal symptoms; however, perianal disease alone can be the initial manifestation of CD. In patients who present only with recurrent perianal abscesses and fistulas, in the absence of a conclusive diagnosis of CD, further investigation is indicated to determine the etiology of the perianal disease. The following cases describe 3 patients with recurrent perianal abscesses, fistulas, or ulcerations who were subsequently diagnosed as having autoimmune neutropenia (AIN), and, once treated for AIN, had complete resolution of their perianal disease.
What is Celiac Disease? Celiac Disease (CD) or gluten-sensitive enteropathy is a T-cell mediated disease occurring in genetically susceptible individuals induced by the ingestion of one of several proteins found in wheat (gliadins), barley (hordeins) and rye (secalinin). Symptoms classically include episodic diarrhea, abdominal pain and distention and weight loss. Approximately one half of adults develop clinically significant diarrhea. Interestingly, only one half of all patients with CD have symptoms referable to the gastrointestinal tract. What is the most common presentation of CD? The most common clinical presentation is iron-deficiency anemia due to both iron malabsorption and occult gastrointestinal bleeding. CD should be considered in any patient presenting with unexplained iron deficiency anemia, even in the absence of gastrointestinal symptoms. Involvement of the small bowel can lead to watersoluble (B12, folic acid) and fat-soluble (A, D, K, E) vitamin malnutrition and calcium deficiency. Thus patients may go on to develop such symptoms as peripheral neuropathy, osteoporosis, ataxia and coagulopathy. Infants with CD typically present with impaired growth, diarrhea and abdominal distention. Older children with severe, untreated CD may develop short stature, pubertal delays, rickets, dental enamel defects, behavioral disturbances and poor school performance. CD is associated with the human leukocyte antigen HLA-DQ2 in 90% to 95% of cases and HLA-DQ8 in the remaining 5% to 10% of cases.
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