American Journal of Pediatrics

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A 17-year-old Girl with Crohn’s Disease: A Case Report

Received: 01 July 2020    Accepted: 13 July 2020    Published: 04 August 2020
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Abstract

The prevalence of inflammatory bowel disease (IBD) in worldwide exceeded 0.3%. The highest prevalence of Crohn’s disease is reported in Germany (322 per 100.000). The incidence and prevalence of IBD relatively low in Asia. In Indonesia, the case of IBD are rarely found. Reported a 5.2% of cases of Crohn’s disease and from the rest of the total cases colonoscopy at Cipto Mangunkusumo Hospital. In majority population, patients with Crohn’s disease usually diagnosed in their 20s and 30s. However 5-10% of all cases occur early in paediatric. The aim of our case report was to describe clinical presentation, laboratory, imaging study and histopathology finding of Crohn’s disease. A 17-year-old girl had reccurent bloody stool, recurrent diarrhea, recurrent stomatitis, pale, abdominal pain, weight loss, and did not have her period since 16-year-old. Physical examination showed cachexia appearance, old man face, prominent costae, tenderness at abdominal palpation, muscle wasting, severe malnutrition, and abnormal puberty stage. The laboratory findings revealed micrositic hypochromic mild anemia, positive fecal test, faecal calprotectin >2.100 ug/g, and hypoalbuminemia. The abdominal Computerized Tomography (CT) scan showed suspect inflamation process in the intestine. The colonoscopy and Esophago Gastro Duodenoscopy (EGD) finding revealed multiple colon ulcers with skip lesions and pangastritis superficialis. The histopathologic finding revealed an active chronic gastritis and colitis. Patient was diagnosed as Crohn’s disease, urinary tract infection, mild microcytic hypochromic anemia due to chronic dissease, secondary amenorrhea, severe marasmic malnutrition condition III rehabilitation phase. Patient got enteral nutrition with 6 weeks, corticosteroid to induce remission for 10 weeks (include tapering dose), omeprazole, antibiotic for urinary tract infection, albumin, vitamin and micronutrient for malnutrition management. After 10 weeks of treatment she had remission. Diagnosis of Crohn disease in adolescent girl is not easy to establish. However, some symptom of upper and lower gastrointestinal tract, extraintestinal manifestation like secondary amenorhea, faecal calprotectin level >2.100 ug/g, along with support finding from colonoscopy and EGD which revealed multiple ulcers in colon with skip lesions, pangastritis superficialis and histopathology result which showed an active chronic gastritis and colitis can be helpful to diagnose the case.

DOI 10.11648/j.ajp.20200603.33
Published in American Journal of Pediatrics (Volume 6, Issue 3, September 2020)
Page(s) 312-316
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Adolescent, Crohn’s Disease, Inflammatory Bowel Disease

References
[1] Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. The Lancet (online serial). Download at 17th June 2018. Access from: http://dx.doi.org/10.1016/S0140-6736(17)32448-0.
[2] Kelompok Studi Inflammatory Bowel Disease Indonesia. Konsensus nasional penatalaksanaan inflammatory bowel disease (IBD) di Indonesia. Jakarta: Perkumpulan Gastroenterologi Indonesia 2011.
[3] Duricova D, Burisch, Jess T, Rousseau CG, Lakatos PL. Age-related differences in presentation and course of inflammatory bowel disease: an update on the population-based literature. Journal of Crohn’s and Colitis. Vol. 8, 2014, pp. 1351-61.
[4] Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet. 2012, pp. 1590-605.
[5] Mazal J. Crohn disease: pathophysiology, diagnosis, and treatment. Radiologic Technology. 2014, pp. 297-316.
[6] Sakamoto N, Kono S, Wakai K, Fukuda Y, Satomi M, Shimoyama T, et al. Dietary risk factors for inflammatory bowel disease a multicenter case-control study in Japan. Inflammatory Bowel Disease. Vol. 25, No. 2, 2005, pp. 154-63.
[7] Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Ulcerative colitis in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival. Gut. Vol. 46, N0. 3, 2000, pp. 336-43.
[8] Bossuyt X. Serologic markers in inflammatory bowel disease. Clinical Chemistry. Vol. 52, No. 2, 2006, pp. 171-81.
[9] Glick SR, Carvalho RS. Inflammatory Bowel Disease. Pediatrics in Review. Vol 32, 2011, pp. 14.
[10] Assche GV, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M. The second european evidence-based consensus on the diagnosis and management of crohn’s disease: definitions and diagnosis. Journal of Crohn’s and Colitis. Vol. 4, 2010, pp. 7-27.
[11] Satsangi J, Silverberg MS, Vermeire S, Colomberl JF. The montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. Vol. 55, 2006, pp. 749-53.
[12] Freout T, Miossec C, Ngahou KB, Dejoie, Flamant M, Maillard O, et al. Ovarian reserve in young women of reproductive age with crohn’s disease. Inflammatory Bowel Disease. 2011, pp. 1-8.
[13] Davis-Kankanamge CN, Bercaw-Pratt JL, Santos XM, and Dietrich JE, Crohn’s disease and gynecologic manifestation in young females, Journal of Pediatric and Adolescent Gynecology. 2016, pp. 1-11.
[14] Alastair F, Emma G, Emma P. Nutrition in inflammatory bowel disease. Journal Parenteral Enteral Nutrition. Vol. 35, 2011, pp. 571-80.
[15] Dignass A, Assche GV, Lindsay JO, Lemann M, Soderholm J, Colombel JF. The second european evidence-based consensus on the diagnosis and management of crohn’s disease: current management. Journal of Crohn’s and Colitis. Vol. 4, 2010, pp. 28-62.
[16] Hoens GD, Baert F, Assche GV, Caeneppeel P, Vergauwe P, Tuynman H. Early combined immunosuppresion or conventional management in patients with newly diagnosed crohn’s disease: an open randomised trial. Lancet. Vol. 371, 2008, pp. 660-7.
[17] Afzal NA, van der Zaag-Loonen HJ, Arnaud Battandier F, et al. Improvement in quality of life of children with acute Crohn’s disease does not parallel mucosal healing after treatment with exclusive enteral nutrition. Alimentary Pharmacology Therapy. Vol. 20, 2004, pp. 167–72.
[18] Yamamoto T, Nakahigashi M, Umegae S, et al. Impact of elemental diet on mucosal inflammation in patients with active Crohn’s disease: cytokine production and endoscopic and histological findings. Inflammatory Bowel Disease. Vol. 11, 2005, pp. 580–8.
[19] Ruemmele FM, Veres G, Kolho KL, Griffiths A, Levine A, Escher JC et al. Consensus Guidelines of ECCO/ESPGHAN on The Medical Management of Pediatric Chron’s Disease. Journal of Crohn’s and Colitis. 2014, pp. 1-28.
[20] Grover Z, Muir R, Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric crohn’s disease. J Gastroenterol. 2013; Download at 17th June 2018.
[21] Johnson T, Macdonald S, Hill S M, Thomas A, Murphy MS. Treatment of active Crohn’s disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut. Vol. 55, 2006, pp. 356-61.
Author Information
  • Department of Child Health, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia

  • Department of Child Health, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia

  • Department of Child Health, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia

  • Department of Child Health, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia

  • Department of Child Health, Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Indonesia

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    Ida Ayu Putu Purnamawati, I Putu Gede Karyana, I Gusti Ngurah Sanjaya Putra, Ni Nyoman Metriani Nesa, I Gusti Lanang Sidiartha. (2020). A 17-year-old Girl with Crohn’s Disease: A Case Report. American Journal of Pediatrics, 6(3), 312-316. https://doi.org/10.11648/j.ajp.20200603.33

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    Ida Ayu Putu Purnamawati; I Putu Gede Karyana; I Gusti Ngurah Sanjaya Putra; Ni Nyoman Metriani Nesa; I Gusti Lanang Sidiartha. A 17-year-old Girl with Crohn’s Disease: A Case Report. Am. J. Pediatr. 2020, 6(3), 312-316. doi: 10.11648/j.ajp.20200603.33

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    AMA Style

    Ida Ayu Putu Purnamawati, I Putu Gede Karyana, I Gusti Ngurah Sanjaya Putra, Ni Nyoman Metriani Nesa, I Gusti Lanang Sidiartha. A 17-year-old Girl with Crohn’s Disease: A Case Report. Am J Pediatr. 2020;6(3):312-316. doi: 10.11648/j.ajp.20200603.33

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  • @article{10.11648/j.ajp.20200603.33,
      author = {Ida Ayu Putu Purnamawati and I Putu Gede Karyana and I Gusti Ngurah Sanjaya Putra and Ni Nyoman Metriani Nesa and I Gusti Lanang Sidiartha},
      title = {A 17-year-old Girl with Crohn’s Disease: A Case Report},
      journal = {American Journal of Pediatrics},
      volume = {6},
      number = {3},
      pages = {312-316},
      doi = {10.11648/j.ajp.20200603.33},
      url = {https://doi.org/10.11648/j.ajp.20200603.33},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajp.20200603.33},
      abstract = {The prevalence of inflammatory bowel disease (IBD) in worldwide exceeded 0.3%. The highest prevalence of Crohn’s disease is reported in Germany (322 per 100.000). The incidence and prevalence of IBD relatively low in Asia. In Indonesia, the case of IBD are rarely found. Reported a 5.2% of cases of Crohn’s disease and from the rest of the total cases colonoscopy at Cipto Mangunkusumo Hospital. In majority population, patients with Crohn’s disease usually diagnosed in their 20s and 30s. However 5-10% of all cases occur early in paediatric. The aim of our case report was to describe clinical presentation, laboratory, imaging study and histopathology finding of Crohn’s disease. A 17-year-old girl had reccurent bloody stool, recurrent diarrhea, recurrent stomatitis, pale, abdominal pain, weight loss, and did not have her period since 16-year-old. Physical examination showed cachexia appearance, old man face, prominent costae, tenderness at abdominal palpation, muscle wasting, severe malnutrition, and abnormal puberty stage. The laboratory findings revealed micrositic hypochromic mild anemia, positive fecal test, faecal calprotectin >2.100 ug/g, and hypoalbuminemia. The abdominal Computerized Tomography (CT) scan showed suspect inflamation process in the intestine. The colonoscopy and Esophago Gastro Duodenoscopy (EGD) finding revealed multiple colon ulcers with skip lesions and pangastritis superficialis. The histopathologic finding revealed an active chronic gastritis and colitis. Patient was diagnosed as Crohn’s disease, urinary tract infection, mild microcytic hypochromic anemia due to chronic dissease, secondary amenorrhea, severe marasmic malnutrition condition III rehabilitation phase. Patient got enteral nutrition with 6 weeks, corticosteroid to induce remission for 10 weeks (include tapering dose), omeprazole, antibiotic for urinary tract infection, albumin, vitamin and micronutrient for malnutrition management. After 10 weeks of treatment she had remission. Diagnosis of Crohn disease in adolescent girl is not easy to establish. However, some symptom of upper and lower gastrointestinal tract, extraintestinal manifestation like secondary amenorhea, faecal calprotectin level >2.100 ug/g, along with support finding from colonoscopy and EGD which revealed multiple ulcers in colon with skip lesions, pangastritis superficialis and histopathology result which showed an active chronic gastritis and colitis can be helpful to diagnose the case.},
     year = {2020}
    }
    

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    AU  - I Putu Gede Karyana
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    AU  - Ni Nyoman Metriani Nesa
    AU  - I Gusti Lanang Sidiartha
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    AB  - The prevalence of inflammatory bowel disease (IBD) in worldwide exceeded 0.3%. The highest prevalence of Crohn’s disease is reported in Germany (322 per 100.000). The incidence and prevalence of IBD relatively low in Asia. In Indonesia, the case of IBD are rarely found. Reported a 5.2% of cases of Crohn’s disease and from the rest of the total cases colonoscopy at Cipto Mangunkusumo Hospital. In majority population, patients with Crohn’s disease usually diagnosed in their 20s and 30s. However 5-10% of all cases occur early in paediatric. The aim of our case report was to describe clinical presentation, laboratory, imaging study and histopathology finding of Crohn’s disease. A 17-year-old girl had reccurent bloody stool, recurrent diarrhea, recurrent stomatitis, pale, abdominal pain, weight loss, and did not have her period since 16-year-old. Physical examination showed cachexia appearance, old man face, prominent costae, tenderness at abdominal palpation, muscle wasting, severe malnutrition, and abnormal puberty stage. The laboratory findings revealed micrositic hypochromic mild anemia, positive fecal test, faecal calprotectin >2.100 ug/g, and hypoalbuminemia. The abdominal Computerized Tomography (CT) scan showed suspect inflamation process in the intestine. The colonoscopy and Esophago Gastro Duodenoscopy (EGD) finding revealed multiple colon ulcers with skip lesions and pangastritis superficialis. The histopathologic finding revealed an active chronic gastritis and colitis. Patient was diagnosed as Crohn’s disease, urinary tract infection, mild microcytic hypochromic anemia due to chronic dissease, secondary amenorrhea, severe marasmic malnutrition condition III rehabilitation phase. Patient got enteral nutrition with 6 weeks, corticosteroid to induce remission for 10 weeks (include tapering dose), omeprazole, antibiotic for urinary tract infection, albumin, vitamin and micronutrient for malnutrition management. After 10 weeks of treatment she had remission. Diagnosis of Crohn disease in adolescent girl is not easy to establish. However, some symptom of upper and lower gastrointestinal tract, extraintestinal manifestation like secondary amenorhea, faecal calprotectin level >2.100 ug/g, along with support finding from colonoscopy and EGD which revealed multiple ulcers in colon with skip lesions, pangastritis superficialis and histopathology result which showed an active chronic gastritis and colitis can be helpful to diagnose the case.
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