A Rare Cause of Rapid Death in Patients With Crohn’s Disease

Abstract

Question: A 35-year-old male patient was hospitalized due to intermittent low back pain, abdominal pain, and fever. He had a 1-year history of suspected ankylosing spondylitis (AS) and had short-term NASIDs use for about 1 month. He was diagnosed as having Crohn’s disease (CD) and AS 1 month before admission. Computed tomography enterography revealed transmural ileocolitis without obvious fistula or abscess and segmental small intestinal lesions (Figure A, B, C). Meanwhile, the patient had bilateral sacroiliitis of grade 2 on computed tomography (CT) scan with no peripheral joint involvement. Anti–tumor necrosis factor therapy was recommended, however, he refused because of the cost and inconvenience. Oral methylprednisolone (0.75 mg/kg/d) and sulphasalazine were effective in improving his abdominal and joint symptoms in the first month after treatment. He continued tapering glucocorticoids until developing fever 4 days before admission.