Failure to Diagnose Failure to Grow

A 14-year-old female presented with a 3-week history of sore throat, hoarseness, croupy nonproductive cough, fever, diarrhea, and 5.5-kg weight loss. She was a poor student and "picky eater," and both her current weight and height (18.5 kg and 128 cm) were far below the fifth percentile. Her apparent failure to thrive was a source of concern, and although her diarrhea appeared to be acute, she began to have guaiac-positive stools, and admitted to chronic episodes of diarrhea and recurrent abdominal pains. A colonoscopy revealed chronic aphthous ulcers consistent with Crohn's disease of the large bowel. She was discharged on nutritional supplements, high-dose prednisone therapy, and mesalimine delayed-release tablets.