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

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.