2017-07-13 13:45:46 UTC

Febrile Attacks With a Refractory Colonic Lesion

July 12, 2017

Gastroenterology image challenge involves a 68-year old woman with refractory inflammatory bowel disease and history of pulmonary tuberculosis.

Gastroenterology Clinical Image Challenge: In April 2015, a 68-year-old woman with refractory inflammatory bowel disease was referred to our hospital for further examination. She had a history of pulmonary tuberculosis. Her symptoms of self-remitting fever, diarrhea and abdominal pain initially occurred in 2005. Colonoscopy revealed multiple erosions with loss of mucosal vascularity throughout the colorectum. Although she was administered 4 g of mesalazine per day, her symptoms recurred. In 2014, ileocolonoscopy showed multiple ulcers and erosions in the terminal ileum and the ascending colon. She was administered 40 mg of oral prednisolone per day. Although her symptoms subsided, ileocolonic involvement remained active under ileocolonoscopy. In February 2015, she had a febrile attack with body temperature over 38°C and abdominal pain that spontaneously subsided within two days. In March, her symptoms repeated and laboratory data showed severe inflammation (white blood cell [WBC] count, 24,350/μL; C-reactive protein [CRP], 15.2 mg/dL) that lead to her referral to our hospital.

On admission, her symptoms subsided and laboratory data only showed mild inflammatory reaction (WBC, 10,140/μL; CRP, 0.18 mg/dL). Immunologic tests revealed negative antinuclear antibody and positive QuantiFERON test. Ileocolonoscopy disclosed erythematous mucosa with multiple ulcers and erosions in the ascending colon (Figure A) and in the terminal ileum (Figure B). Other small intestinal involvement was not found under capsule endoscopy or balloon-assisted endoscopy.

What is the diagnosis?

To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play.

More on Colonoscopy

Important Opportunity to Advise CMS on Colonoscopy Episode

Oct. 26, 2017

It is critical that you share your feedback with CMS by Wednesday, Nov. 15.

Tips to Avoid a 2019 Payment Penalty

Oct. 19, 2017

Report on one measure for one patient for the 2017 Quality Payment Program Performance Year.

Colonoscopy Cost Measure to be Tested for MIPS

Oct. 4, 2017

Prepare now to share your thoughts on the value of the measure with CMS.