Intestinal Behcetʼs or Crohnʼs Disease

Abstract

Purpose: Intestinal Behçet's disease (BD) and Crohn's disease (CD) are chronic inflammatory bowel diseases that are difficult to distinguish from each other. We present a case of intestinal BD which was very difficult to differentiate from CD. Case: 29-year-old male with history of occasional oral ulcers presented with diarrhea, abdominal pain and fevers after eating raw oysters. His partner developed the same symptoms which resolved after taking metronidazole (MTZ) and ciprofloxacin (Cip). Patients symptoms improved after taking MTZ and Cip, but returned 1 week later with diarrhea, painful scrotal ulcers (Figure 1), right wrist pain, sore throat and oral thrush. He also had ulcers on the uvula, cervical and inguinal lymphadenopathy, and multiple small pustular lesions over the body. His albumin was 1.8 mg/dl, hemoglobin 9.7 gm/dl and stool positive for Clostridium difficle toxin. A MR enterography showed diffuse thickening of descending colon and loss of haustra. Flexible Sigmoidoscopy with biopsy showed severe active colitis with cryptitis and ulcerations in the colon and mild patchy proctitis. Patient was started on IV MTZ, oral vancomycin and IV methylprednisolone 60 mg BID. There was immediate improvement in his symptoms and he was discharged from the hospital 4 days later. Discussion: The prevalence of intestinal BD is 1-2% in BD and can have similar presentation as Crohn's disease. The ulceration can be found throughout the colon, but mostly frequently found in the ileocecal region. Our patient met the criteria by international study group for BD with having recurrent oral ulcerations, genital ulcer and involvement of the colon. HLA-B51 allele positive patients have higher prevalence in Japan and eastern Asia and more severe disease. The cummulateive use of steroids and higher number of ulcers are associated in patients with Anti Alpha Enolase Antibody. Endoscopically a round, less than 6 ulcers and absence of cobblestoning is helpful to differentiate intestinal BD from CD. Corticosteriods are the drug of choice for active disease. Azathioprine, colchicine, infliximab, dapsone and tacrolimus have been used for maintenance of intestinal BD. This case highlights the difficulty in differentiating intestinal BD from CD.Figure: [1254] Scortal ulcer.