Crohn's colitis in a 10 year old boy

Backround and Aims: Crohn’s disease is a chronic, granulomatous, inflammatory bowel disease which can affect the entire gastrointestinal tract and extraintestinal organs but it is most commonly located in the terminal ileum. Rarely occurs in children under 10 years of age. This is a rare case of Chrohn’s colitis in a young boy.
Matherial and Maethods: 10 year old boy presented with liquid stools in the past 4 months, perianal abscess and fistula treated surgically. On examination: wide anal opening with purulent secretion, a site of a previous fistulous opening was seen, anal sphincter with lost tone. Blood tests: Hgb= 102 g/l, Hct= 31,9%, Wbc= 12,5x109/l, CRP= 28,7mg/l, Serum Iron= 4umol/l, Vitamin D= 20ng/ml. Immunological tests were realized–ASCA IgA= 313IE/ml, fecal calprotectin >2285,70mg/kg. Esophagogastroduodenoscopy:The antral gastric mucosa is discretely hyperemic. Colonosopy:The terminal ileal mucosa is diffusely inflamed, numerous ulcers are seen, the mucosa of the valvular region, cecum, and colon ascendens, also markedly inflamed, with numerous aphthous erosions and irregular ulcers with fibrin exudates. Mucosa of the rectum, sigma, colon descendens and transferum with rare aphthous erosions in several places.
Results: Colon biopsy with pathohistological findings in support of Crohn’s disease. The child was prescribed Prednisone 2x20 mg, Mesalazine 3x500 mg, Omeprazole 1x20 mg, Vitamin D 1x1000 mg. Due to the frequent stools, the dose of mesalazine was increased 3x1 g and Azathioprine was introduced.
Conclussion: Crohn's disease is rare in childhood, especially as Crohn's colitis and should be considered in children with chronic diarrhea and perianal changes such as fistula and abscess.