Unusual Manifestation of Ulcerative Colitis

Ahmed, Amna Basheer M.; Alsaleem, Badr

doi:10.1155/2019/5163213

Cited by 7 publications

(9 citation statements)

References 15 publications

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“…A minority of patients with CNO are found to have IBD. At the time of writing, there have been only 25 case reports of IBD-associated CNO among children and this is the first report in a child with ASD, for whom developmental/language delay and suspected nutritional deficiencies complicated the diagnosis ( 18 – 24 ). Among patients with IBD-associated CNO, it is common for CNO symptoms to precede gastrointestinal symptoms, which may also contribute to diagnostic delay ( 18 ).…”

Section: Discussionmentioning

confidence: 96%

“…At the time of writing, there have been only 25 case reports of IBD-associated CNO among children and this is the first report in a child with ASD, for whom developmental/language delay and suspected nutritional deficiencies complicated the diagnosis ( 18 – 24 ). Among patients with IBD-associated CNO, it is common for CNO symptoms to precede gastrointestinal symptoms, which may also contribute to diagnostic delay ( 18 ). As with this patient, the majority of patients with IBD-associated CNO are ultimately found to have Crohn’s disease rather than ulcerative colitis ( 19 ).…”

Section: Discussionmentioning

confidence: 96%

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Chronic Non-infectious Osteomyelitis Mimicking Scurvy as the Presenting Sign of Crohn’s Disease: Case Report

et al. 2022

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Chronic non-infectious osteomyelitis (CNO) is a rare, inflammatory process associated with pediatric inflammatory bowel disease (IBD). Signs and symptoms of CNO parallel scurvy, a nutritional deficiency that can affect children with autism spectrum disorder (ASD). This is the first report of a child initially thought to have scurvy, then subsequently diagnosed with CNO as the presenting manifestation of Crohn’s disease. This case enhances the literature elucidating extra-intestinal manifestations of IBD and pediatric nutritional deficiencies.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Chronic Non-infectious Osteomyelitis Mimicking Scurvy as the Presenting Sign of Crohn’s Disease: Case Report

et al. 2022

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“…Nonspecific elevation of inflammatory markers, ESR and CRP, may be seen in some cases, although they are normal in the majority of cases at presentation. 5,6 The utility of laboratory workup is limited in the diagnosis of CRMO, and it is mainly used to rule out other causes of symptoms as CRMO has broad differentials. Laboratory workup may be particularly helpful to rule out infectious etiologies and malignancy.…”

Section: Discussionmentioning

confidence: 99%

Chronic Neck Pain and Swelling in a Teenage Patient: An Unusual Association of Inflammatory Bowel Disease

Shamim

Khan

Absah

2022

Clin Pediatr (Phila)

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A teenage girl was diagnosed with inflammatory bowel disease (IBD) when she presented with abdominal pain, diarrhea, hematochezia, and anemia for several months. She had endoscopic assessments, including colonoscopy and esophagogastroduodenoscopy (EGD). Her colonoscopy revealed mucosal inflammation and ulceration (Figure 1). Her EGD and small bowel imaging including magnetic resonance enterography (MRE) did not reveal any small bowel involvement. Her biopsies from EGD were normal while biopsies from colonoscopy showed chronic inflammation, consistent with ulcerative colitis. She was managed with an antitumor necrosis factor (anti-TNF) agent (infliximab) for the treatment of ulcerative colitis. Her disease activity decreased and infliximab use resulted in clinical remission. She developed a significant skin rash consistent with psoriasis that did not respond to topical therapy. Subsequently, anti-TNF therapy was stopped and she was switched to an anti-interleukin (IL)-12 and IL-23 agent (ustekinumab) because of psoriatic rash. Her skin rash resolved and she remained in clinical remission from an IBD standpoint based on her symptoms, labs, and physical examination.About 2 years after the diagnosis of ulcerative colitis, she developed pain in her back and left lower neck (clavicular area). She had an X-ray of the neck and chest that were normal and did not show any findings to explain her symptoms. Initially, she had only intermittent and mild symptoms of pain but gradually, over time, her pain became worse. She also developed swelling in the clavicular area. She was managed with acetaminophen that resulted in resolution of her back pain, but she continued to have significant pain and swelling around her clavicle area. She was referred to orthopedics for further evaluation. She was diagnosed with Tietze syndrome. The pain slowly became debilitating and did not respond to pain medications. She also developed significant tenderness with profound swelling. She had no joint involvement or fever. Consequently, she underwent magnetic resonance imaging (MRI) of the neck for further evaluation.

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“…Although poorly understood, CNO is often considered a rare extraintestinal manifestation of IBD [5]. The association of CNO with ulcerative colitis (UC) is less frequently reported compared to that with Crohn's disease (CD) [6]. CNO can often precede the symptoms of other autoinflammatory diseases such as IBD, making it important for physicians to stay attentive to new symptoms during the disease evolution.…”

Section: Introductionmentioning

confidence: 99%

A severe presentation of chronic non-infectious osteomyelitis associated with ulcerative colitis: a case report

et al. 2020

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Background: Chronic Non-Infectious Osteomyelitis (CNO) is a chronic, relapsing, self-limiting inflammation of the bone. Although it is rare, CNO has been associated with inflammatory bowel disease and frequently precedes the initial diagnosis. We present a case of CNO in a patient with known ulcerative colitis in clinical remission who presented with purulent multifocal joint effusions in the setting of elevated inflammatory markers and fever suspicious for bacterial osteomyelitis. Case presentation: Our patient is a 12-year-old girl with ulcerative colitis who presented with fevers and insidious onset of joint pain at multiple sites. She had multiple joint effusions on imaging and blood and joint cultures were negative. Biopsy of the left acromion demonstrated acute and chronic osteomyelitis with areas of necrosis and granulomatous inflammation suggestive of CNO. Patient was started on high dose corticosteroids as well as methotrexate injections with marked improvement in symptoms. Conclusion: This case highlights that while purulent effusions are often indicative of bacterial osteomyelitis, the consideration of CNO in a patient with inflammatory bowel disease (IBD) with multifocal small bone involvement and negative blood cultures should be considered.

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Unusual Manifestation of Ulcerative Colitis

Cited by 7 publications

References 15 publications

Chronic Non-infectious Osteomyelitis Mimicking Scurvy as the Presenting Sign of Crohn’s Disease: Case Report

Chronic Non-infectious Osteomyelitis Mimicking Scurvy as the Presenting Sign of Crohn’s Disease: Case Report

Chronic Neck Pain and Swelling in a Teenage Patient: An Unusual Association of Inflammatory Bowel Disease

A severe presentation of chronic non-infectious osteomyelitis associated with ulcerative colitis: a case report

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