Abstract Ref Number = APCP885
PEDIATRIC CROHN DISEASE WITH EXTRAINTESTINAL SKIN AND EYE MANIFESTATIONS AND HIGH IMMUNOGLOBULIN LEVELS: AN INTERESTING CASE REPORT
Budi Purnomo, Eva Jeumpa Soelaeman, Karina Kalani Firdaus, Ariani Dewi Widodo
Gastrohepatology Working Group, Department of Pediatrics, Harapan Kita Women and Children Hospital, Jakarta
General Practitioner, Harapan Kita Women and Children Hospital, Jakarta
Background: Crohn’s Disease (CD)is anchronic inflammatory bowel disease that can affect any part of the intestinal tract. It is characterized with intestinal manifestations/IM(abdominal pain, weight loss, diarrhea, hematoschezia, growth failure) and extraintestinal manifestations/EIM(fever, arthritis, uveitis, erythema nodosum or pyodermagangrenosum). In most CD patients, serum immunoglobulins are normal, but there are reports of hypergammaglobulinemiafound to be closely linked to CD. Majority of children with hypergammaglobulinemia had EIM that affects joints, skin, eyes, and mouth.
Case Presentation/Summary: A six-year-old male patientpresented with a history ofabdominal pain and blood-taintedstools since 1 year ago. Patient also reported recurrent itchy scaly scalp, itchy eyes, and recurrent red, painful node on the legs. Upon admission, patient had microcytic anemia (Hb 7.8, MCV 62, MCH 18,MCHC 29), leukocytosis (17.410), thrombocytosis (762.000), hypoalbuminemia (2.5), increased hs-CRP levels (59.5) Fecal calprotectin was increased (1,187.3) Fecal evaluation positive for blood, mucus, and amoeba. Immunologic profile showed increased immunoglobulin (Ig) A (576), IgG (2536),IgM (796) and normal totalIgE levels (31.9). IgEatopy panel showed very weak antibody detection for cow’s milk and bovine serum albumin. Colonoscopy showed multiple ulcers in the sigmoid and descending colon with overall congested mucosa especially in the rectum, and pseudomembraneat the mucosa of the anus. Diagnosis of inflammatory bowel disease was concluded. Patient was also diagnosed with atopic and seborrhoic dermatitis, uveitis, and allergic conjunctivitis.
Learning Point/Discussion: CD is an immune-mediated chronic inflammatory bowel disease. Extraintestinal manifestations are not commonly found in CD but if found, especially if multiple times and recurrent, should be suspected of increased levels of immunoglobulins(hypergammaglobulinemia) and should be evaluated and treated accordingly because of the potential recurrence.
Keywords: Crohn’s disease autoimmune extraintestinal manifestation hypergammaglobulinemia