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Journal of Crohn's and Colitis: 9 (7)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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Adult-onset Still's disease preceding Crohn's disease

Konstantinos H. Katsanos , Vasiliki Siozopoulou , Dimitrios Sigounas , Vasileios E. Tsianos , Dimitrios Christodoulou , Vasiliki Mitsi , Epameinondas V. Tsianos
DOI: http://dx.doi.org/10.1016/j.crohns.2012.05.019 e93-e98 First published online: 1 April 2013

Abstract

Concomitant diagnosis of Crohn's disease and juvenile or adult-onset idiopathic arthritis is rare. It is possible that both conditions share some genetic or immunological defects although sufficient data are lacking.

We describe herein the first case of a patient with adult-onset Still's disease who was diagnosed on follow up with concomitant Crohn's disease.

A 38-year-old man diagnosed with adult onset Still's disease from the age of 24 was admitted in our hospital because of bloody diarrhea. On admission physical examination was unremarkable and all routine laboratory tests were normal except of Hg at 11.3 gr/dl, erythrocyte sedimentation rate at 27 mm/h and C-reactive protein at 14 mg/dl.

Ileocolonoscopy revealed small aphthoid ulcers in the terminal ileum and capsule endoscopy revealed the source of bleeding and small aphthoid ulcers starting from the distal jejunum up to the terminal ileum. Terminal ileum biopsies were diagnostic of Crohn's disease and patient had started on therapy with mesalamine 2 gr/day and azathioprine 2 mg/kg and is currently on multidisciplinary follow up.

We review all literature on co-existence of Crohn's disease with chronic idiopathic arthritis and we discuss the possible difficulties in diagnosis and therapy of those patients also in the view of the new biological agents.

Keywords
  • Crohn's disease
  • Juvenile idiopathic arthritis
  • Adult onset Still's disease
  • Etanercept
  • Infliximab
  • Adalimumab
  • Abbreviations
    CD
    Crohn's disease
    UC
    ulcerative colitis
    IBD
    inflammatory bowel disease
    JIA
    Juvenile idiopathic arthritis
    AOSD
    Adult onset Still's disease
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