A rare case of fever as the main symptom of Crohn's disease manifestation

Cover Page

Cite item

Abstract

Crohn's disease is a chronic, recurring gastrointestinal tract disease of unknown etiology with alternating periods of exacerbations and remissions; however, some patients can have a fulminant disease with predominance of fever. In some cases, extraintestinal manifestations of the disease (arthritis, sacroiliitis, aphthous stomatitis) come to the fore. This paper presents a clinical case of a 46 years old patient Z., who was treated in the Republican Clinical Hospital (Kazan, Russia). His past history was remarkable for a painful ulceration of the oral mucosa about 1.5 months ago, after a planned replacement of a removable prosthesis on the lower jaw. The patient was diagnosed with "decubital ulcer of the oral mucosa in the right retro-molar area"; malignancies were excluded, and anti-inflammatory therapy was initiated. Then he had fever of up to 39.5 °C and abdominal pains. The infectious causes of fever were excluded, abdominal ultrasound showed no free fluid in the abdominal cavity, and macroscopic segmental erosive-ulcerative changes of the colon, specific for Crohn's disease were found at colonoscopy. Intravenous prednisolone was initiated, with augmentation of infusions and administration of protein and antibacterials. The next day abdominal pain became more severe, with vomiting, abdominal distension, Blumberg's sign; blood pressure was 90/60 mm Hg and heart rate 120 beats perminute. Abdominal ultrasound showed free fluid in the abdominal cavity; dilated intestine loops with horizontal fluid levels were seen at X-ray. The diagnosis was "advanced peritonitis, hollow organ perforation", and emergency laparotomy was performed that showed multiple perforations of the colon and sigmoid, diffuse fibrinous-purulent fecal peritonitis. Colectomy and end ileostomy were performed. Despite intensive therapy in the intensive care unit, the patient's general condition continued to worsen, and two days after the operation, with deterioration of cardiovascular failure, he died. Based on the histological examination of the colon and the autopsy results, the diagnosis of Crohn's disease was confirmed. Thus, the presence of febrile fever, as the leading syndrome, without any intestinal symptoms, should be included in the differential diagnostic list of symptoms of Crohn's disease.

About the authors

A. Kh. Odintsova

Republican Clinical Hospital, Department of Health of the Republic of Tatarstan

Email: fake@neicon.ru

Alfiya Kh. Odintsova - MD, PhD, Head of the Department of Gastroenterology.

138 Orenburgskiy trakt, Kazan, 420064.

 

Russian Federation

E. S. Bodryagina

Kazan State Medical University

Author for correspondence.
Email: snezenka@rambler.ru

Evgeniya S. Bodryagina - MD, PhD, Assistant, Chair of Hospital Therapy.

49 Butlerova ul., Kazan, 420012.

Tel.: +7 (917) 395 34 55.

Russian Federation

N. A. Cheremina

Republican Clinical Hospital, Department of Health of the Republic of Tatarstan

Email: fake@neicon.ru

Natal'ya A. Cheremina - MD, Gastroenterologist, Department of Gastroenterology.

138 Orenburgskiy trakt, Kazan, 420064.

 

Russian Federation

D. I. Abdulganieva

Republican Clinical Hospital, Department of Health of the Republic of Tatarstan; Kazan State Medical University

Email: fake@neicon.ru

Diana I. Abdulganieva - MD, PhD, Professor, Chief of the Therapeutic Clinic Republican Clinical Hospital, Department of Health of the Republic of Tatarstan; Head of the Chair of Hospital Therapy Kazan State Medical University.

138 Orenburgskiy trakt, Kazan, 420064. 49 Butlerova ul., Kazan, 420012.

Russian Federation

References

  1. Ивашкин ВТ, Шелыгин ЮА, Халиф ИЛ, Белоусова ЕА, Шифрин ОС, Абдулганиева ДИ, Абдулхаков РА, Алексеева ОП, Алексеенко СА, Ачкасов СИ, Барановский АЮ, Болихов КВ, Валуйских ЕЮ, Варданян АВ, Веселов АВ, Веселов ВВ, Головенко АО, Головенко ОВ, Григорьев ЕГ, Губонина ИВ, Жигалова ТН, Кашников ВН, Кизова ЕА, Князев ОВ, Костенко НВ, Куляпин АВ, Морозова НА, Муравьев АВ, Низов АА, Никитина НВ, Николаева НН, Никулина НВ, Одинцова АХ, Осипенко МФ, Павленко ВВ, Парфенов АИ, Полуэктова ЕА, Потапов АС, Румянцев ВГ, Светлова ИО, Ситкин СИ, Тимербулатов ВМ, Ткачев АВ, Ткаченко ЕИ, Фролов СА, Хубезов ДА, Чашкова ЕЮ, Шапина МВ, Щукина ОБ, Яковлев АА. Клинические рекомендации Российской гастроэнтерологической ассоциации и Ассоциации колопроктологов России по диагностике и лечению болезни Крона. Колопроктология. 2017;(2):7-29.
  2. Wang G, Ma Y, Chen L, Ma C. Paediatric gastric and intestinal Crohn's disease detected by (18)F-FDG PET/CT. Hell J Nucl Med. 2014;17(3): 208-10.
  3. Kambouri K, Gardikis S, Agelidou M, Vaos G. Local peritonitis as the first manifestation of Crohn's disease in a child. J Indian Assoc Pediatr Surg. 2014;19(2):100-2. doi: 10.4103/0971-9261.129606.
  4. Gomollon F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, Peyrin-Biroulet L, Cullen GJ, Daperno M, Kucharzik T, Rieder F, Almer S, Armuzzi A, Harbord M, Langhorst J, Sans M, Chowers Y, Fiorino G, Juillerat P, Mantzaris GJ, Rizzello F, Vavricka S, Gionchetti P; ECCO. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis. 2017;11 (1 ):3-25. doi: 10.1093/ecco-jcc/jjw168.
  5. Грищенко ЕГ, Николаева НН, Николаева ЛВ, Байкова ОА, Чупахина ВА. Трудности диагностики болезни Крона верхних отделов желудочно-кишечного тракта. Сибирское медицинское обозрение. 2013;(6):49-54.
  6. Бойко ТИ. Внекишечные проявления воспалительных заболеваний кишечника. Новости медицины и фармации. 2010;(18):20-1.
  7. Халиф ИЛ. Болезнь Крона: диагностика и лечение. Consilium Medicum. 2005;(6): 424-9.
  8. Freeman HJ. Spontaneous free perforation of the small intestine in adults. World J Gastroenterol. 2014;20(29):9990-7. doi: 10.3748/wjg.v20.i29.9990.
  9. Абдулганиева ДИ, Одинцова АХ, Мухаметова ДД, Бодрягина ЕС, Рамазанова АХ, Черемина НА, Афанасьева ТЮ. Региональный регистр по болезни Крона как инструмент проспективного наблюдения за пациентами. Практическая медицина. 2014;(4-1): 17-9.

Supplementary files

There are no supplementary files to display.


Copyright (c) 2018 Odintsova A.K., Bodryagina E.S., Cheremina N.A., Abdulganieva D.I.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies