Knee Pain and Swelling Due to Crohn Disease: A Case Report

Abstract

A lthough peripheral arthritis is the most common extra-intestinal manifestation of inflammatory bowel disease, it is very rarely addressed in the orthopaedic literature. The overwhelming majority of patients with inflammatory bowel disease present with gastrointestinal symptoms and do not have any joint involvement until much later. We present the case of a patient who had joint pain and swelling but lacked any sign of gastrointestinal involvement. After five months of work-up, the patient was diagnosed with Crohn disease and the joint symptoms improved with appropriate medical treatment. We believe that inflammatory bowel disease should be considered in the differential diagnosis of joint pain and swelling. Our patient was informed that data concerning the case would be submitted for publication. A twenty-two-year-old male active-duty sailor in the United States Navy presented with a six-week history of right knee pain following a twisting injury that he had sustained while climbing a ladder on a ship; the knee twisted as the trunk rotated on the planted ipsilateral foot. At the time of the initial orthopaedic evaluation, the patient reported that pain and swelling in the right knee had failed to respond to a course of anti-inflammatory medication and activity modification. There was no history of clicking, catching, locking, or snapping. A review of systems was negative for fevers, chills, nausea, vomiting, recent sexual contact, recent weight loss, loose stools, abdominal pain, or a history of other joint pain or swelling. Physical examination of the knee revealed a moderate effusion, normal appearance of the skin, mild warmth to touch, and decreased range of motion from 0° to 100° secondary to pain and swelling. There was diffuse tenderness of the anterior fat pad but no tenderness at the joint line. Provocative testing of the knee in varus and valgus, the Lachman test, the McMurray test, …