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Unusual presentation of Crohn’s disease
  1. Kate Edwards and
  2. Karen Yearsley
  1. Gastroenterology, Nevill Hall Hospital, Abergavenny, UK
  1. Correspondence to Dr Kate Edwards; kate.edwards8{at}wales.nhs.uk

Abstract

A previously well 37-year-old woman attended the emergency assessment unit with symptoms of lethargy, breathlessness and peripheral oedema, whereby initial basic investigations revealed an iron deficiency anaemia and serum hypoalbuminaemia. The patient subsequently had multiple admissions to secondary care over a 2-year period due to worsening peripheral and central oedema. Investigations ruled out non-gastrointestinal causes of serum hypoalbuminaemia, such as renal, cardiac and hepatic failures. Gastrointestinal investigations later revealed raised faecal alpha-1 antitrypsin and small bowel ulceration on capsule endoscopy, with a histological diagnosis of Crohn’s disease made after a small bowel wedge resection. This case describes the unusual presentation of Crohn’s disease displaying symptoms primarily of protein-losing enteropathy, an uncommon and under-recognised consequence of inflammatory bowel disease. A review of current literature and the underlying pathophysiology for this rare condition are discussed, particularly in relation to Crohn’s disease.

  • endoscopy
  • Crohn's disease
  • small intestine

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Footnotes

  • Twitter @KateEd89

  • Contributors KY was involved in the patient’s management, which is currently ongoing, and highlighted the case as one to write. KY was involved with editing of the case report. KE wrote the case report and undertook a literature search of the subject.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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