An Interesting Case of Misdiagnosed Inflammatory Bowel Disease With Immunoproliferative Small Intestine Disorder

Abstract

Introduction: Inflammatory bowel disease (IBD) prevalence is increasing in Asia. Clinicians are faced with misdiagnosis for IBD even with classic symptoms. This case report shows that how a delayed diagnosis of IBD can produce significant problems for patient. Case Presentation: A 45 year-old man and known case of IPSID (Immunoproliferative small intestine disorder) was referred for follow-up to our GI (Gastrointestinal) clinic. He presented with a history of intractable watery diarrhea along with slight weight loss for the last 22 years. He was admitted with an episode of severe abdominal pain and acute peritonitis 10 years ago. At the time, laparotomy was performed due to a suspicious appendicular mass; however, the surgeon discovered a cecum mass and extended adhesion during laparotomy. According to IPSID diagnosis, he was then referred to an oncologist who treated him with chemotherapy and patient was advised to attend an annual colonoscopy checkup as follow-up. He was gradually complicated by renal stones, arthritis, hypoalbuminemia and bone disease during the follow-up. We as gastroenterologists reviewed his history again and requested a revision for all histopathology results by GI pathologist. Pathologist confirmed IBD (Crohn’s disease) from the first pathology and his treatment was started immediately. Discussion: Several diseases can mimic IBD symptoms but with careful consideration of patient’s symptoms, endoscopic findings and pathology results one should be able to diagnose IBD. Correct diagnosis of IBD can affect the quality of life of patient.