A case of terminal ileitis that was not Crohn’s disease

Abstract

Currently, there is an increase in the incidence of inflammatory bowel disease in children, including Crohn’s disease. Detection of typical endoscopic signs is the gold endoscopic standard for this disease diagnosis. When such endoscopic picture is accompanied by chronic diarrhea, abdominal pain, weight loss, and laboratory changes in the form of increased levels of faecal calprotectin and C-reactive protein, the diagnosis of Crohn’s disease becomes apparent and the diagnostic search is stopped. But there are other diseases, including of infectious type, that may have similar clinical, laboratory and endoscopic symptoms, which should be included in the scope of diagnostic search.

Aim. To acquaint physicians with the features of diagnosis and monitoring of a patient with Yersinia infection on the background of lactase deficiency, clinically reminiscent of Crohn’s disease.

Clinical case. A boy, 14 years old, complained of abdominal pain, recurrent diarrhea, weakness, lack of weight gain. A mother considered the child sick for 9 months, when periodic abdominal pain, diarrhea up to 10–12 times a day, sometimes nausea and vomiting occurred. Over time, episodes of diarrhea became more frequent, mainly after drinking milk. Four months after the disease onset, the child lost appetite, developed weakness, abdominal pain, recurrent diarrhea, no weight gain with increasing body length. Eight months after presenting complaints, the child was admitted to a hospital with acute disease manifestations (fever, abdominal pain, vomiting, diarrhea for 10 days). The boy was examined by a surgeon and a pediatric gastroenterologist. During colonoscopy, terminal ileitis was detected. The boy received non-specific treatment (mesalazine 3 g/day, etc.), there was a rapid improvement: abdominal pain disappeared, asthenic syndrome regressed, diarrhea reduced. Although amnestic, clinical, laboratory and instrumental data were very characteristic of Crohn’s disease, the diagnosis was questionable due to the lack of inflammatory changes in the general blood test and the fact that spontaneous remission of such severe exacerbation, for which mesalazine was usually ineffective. It was necessary to exclude other causes of inflammation of the small intestine (intestinal infections, tuberculosis). RNGA with pseudotuberculosis diagnosticum gave a positive result (intestinal yersiniosis diagnosticum O3).

Conclusions. In children with suspected inflammatory bowel disease, intestinal infections, namely yersinia infection, should be ruled out as the cause of symptoms. Even with clear manifestations of terminal ileitis, which is characteristic of Crohn’s disease, the results of intestinal endoscopy may be relatively nonspecific, so the disease history, a correspondence with laboratory results, serological markers of some infectious diseases should also be taken into account in the diagnostic process for the ileitis etiology.