Atypical Presentation of Small Bowel Crohn's Disease: Case Report of Musculoskeletal and Hepatic Complications Without Gastrointestinal Symptoms

Yiyi Chen; Fei Wang; Lingna Xu; Qinbing Ke; Shujuan Ji; Jie Mao; Xiya Jia; Chuanxi Lai; Sheng Dai

doi:10.2147/JIR.S500687

Atypical Presentation of Small Bowel Crohn's Disease: Case Report of Musculoskeletal and Hepatic Complications Without Gastrointestinal Symptoms

J Inflamm Res. 2024 Dec 16:17:11129-11135. doi: 10.2147/JIR.S500687. eCollection 2024.

Authors

Yiyi Chen^{1

2}, Fei Wang^{1

2}, Lingna Xu^{1

2}, Qinbing Ke³, Shujuan Ji⁴, Jie Mao⁵, Xiya Jia^{1

2}, Chuanxi Lai^{1

2}, Sheng Dai^{1

2}

Affiliations

¹ Department of Colorectal Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, People's Republic of China.
² Provincial Key Laboratory of Precise Diagnosis and Treatment of Abdominal Infection, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, People's Republic of China.
³ Department of Radiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, People's Republic of China.
⁴ Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, People's Republic of China.
⁵ Department of Pathology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, People's Republic of China.

Abstract

Herein, we described a case of small bowel Crohn's disease with recurrent, unexplained fevers, pain in the right lower back, hip, and groin area over 20 months. The patient did not present any gastrointestinal symptoms and colonoscopy showed no abnormalities. Imaging revealed a liver abscess and multiple lesions with pneumatosis in the muscles of the right lower back region. Initially, disseminated infection was suspected and the antibiotics was administered without success. Subsequently, Magnetic resonance (MR) enterography suggested the possibility of a small bowel fistula which was confirmed during exploratory laparotomy. Inflammation was prominent in a 27-cm segment starting from 30-cm proximal to the ileocecal junction. The segment was resected and pathological examination confirmed Crohn's disease. Postoperatively, mesalazine was administered, but showed limited efficacy. After modifying the treatment plan to infliximab and azathioprine, the patient was symptom-free and no obvious inflammation was found in the colonoscopy reexamination.

Keywords: extraintestinal manifestations; inflammatory bowel disease; liver abscesses; small bowel Crohn’s disease.

Publication types

Case Reports

Grants and funding

This study was funded by National Natural Science Foundation of China (32200593) and key research and development program of Zhejiang province(2022C03032).