Diagnostic Problems in Crohn's Disease: A Case Report

Abstract

Crohn’s disease is marked by transmural inflammation of the digestive tract and is categorized into inflammatory bowel disease (IBD). In Indonesia, Simadibrata et al, reported 20% from 107 patients who experienced non-infective chronic diarrhea, actually suffered from IBD. A 33-year old male patient complained of watery stool since 3 months before hospital admission. He experienced stabbing stomachache and loss of body weight. Physical and laboratory examination results were within normal limits. Faecal analysis revealed intestinal infection caused by gram-negative bacteria and intestinal maldigestion. Colonoscopy examination exhibited the presence of hyperemic mucosa, edematous, and positive cobblestone appearance in the terminal ileum. Additionally, the histological evaluation showed the impression of chronic ileitis usually found in IBD. Meanwhile, moderate pangastritis was obtained in the esophagoduodenoscopy examination. results of histological biopsy of the antrum showed absence of Helicobacter pylori infection. An active lesion in chronic ileitis was found in immunohistochemistry examination. Acid fast bacterial culture was also performed to the ileum tissue and revealed negative results in clinical microbiology examination. From the examinations conducted, patient was diagnosed as Crohn’s disease and treated with budesonide capsule 3 mg and mesalazine tablet 1,000 mg twice daily. Later, he felt improvement of the complains. This case illustrated Crohn’s disease which is rarely found in Indonesia. This is because diagnosis requires supporting examinations which could only be done in tertiary health care facilities. However, possibility of other diagnosis should be considered, particularly intestinal tuberculosis and infective colitis. Early diagnosis and prompt treatment may improve patient’s prognosis and quality of life. Keywords: IBD, Crohn’s disease, positive cobblestone