Simultaneous Presentation of Celiac Disease and Ulcerative Colitis, Was Wrongly Considered Crohnʼs Disease in a Child

Abstract

Occurrence of IBD and CD disease simultaneously in children is uncommon. Few reports about the frequency and management of similar cases are available in the literature. Case presentation: 17 Yo female presented with bloody diarrhea, abdominal pain and weight loss. Endoscopic evaluation showed normal TI, pan colitis, nonspecific gastritis and duodenitis with villous atrophy. Diagnosis of Crohn's was made and patient started 6MP and steroids. She didn't tolerate 6MP and symptoms persisted. Second opinion was obtained, review of the biopsies suggested features of UC and duodenal changes consistent with CD. Patient started sulfasalazine that resulted in some clinical improvement, but the weight and hair loss persisted. Repeated scopes showed improved colonic inflammation with persistent duodenal changes. Finally CD serum markers were checked and they were positive (tTg IgA 123), patient started gluten free diet that resulted in clinical remission and weight gain. Discussion: Finding of upper GI involvement in IBD patient is common and not enough to make Crohn's diagnosis. It was not clear if the SB involvement in our patient was part of her UC or true coincidence of CD. Reports of false positive CD titers in IBD patients, especially Crohn's disease, are available. Persistent of SB changes despite proper UC treatment and the improvement after starting gluten free diet suggested true coincidence of UC and CD. Conclusion: This case suggests an association between UC and CD. Also shows the importance of screening for CD with serum titers in IBD patients with SB involvement, when there is persistence of symptoms, histologic changes and frequent relapses.