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Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
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Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
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Crohn's Disease Causes a Catastrophe.

Anam Khan1, Yamini Natarajan2, Joseph Sellin2

  • 1Department of Internal Medicine, Baylor College of Medicine, Houston, TX.

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|July 10, 2015
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Summary
This summary is machine-generated.

Patients with Crohn's disease face a higher risk of antiphospholipid antibody syndrome (APS), a condition that can lead to catastrophic APS (CAPS). This case highlights a severe presentation in a young male with Crohn's disease.

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Area of Science:

  • Internal Medicine
  • Gastroenterology
  • Rheumatology

Background:

  • Crohn's disease (CD) is an inflammatory bowel disease associated with an increased risk of antiphospholipid antibody syndrome (APS).
  • Antiphospholipid antibody syndrome (APS) can manifest in a severe, life-threatening form known as catastrophic APS (CAPS), characterized by rapid, widespread clotting.

Observation:

  • A 17-year-old male with a history of Crohn's disease presented with gastrointestinal bleeding and abdominal pain.
  • The patient rapidly developed multiple thrombotic and organ-damaging events, including myopericarditis, alveolar hemorrhage, cerebral infarcts, superior sagittal sinus venous thrombosis, disseminated intravascular coagulation, and pulmonary embolism.

Findings:

  • The patient's clinical presentation and thrombotic events were consistent with catastrophic antiphospholipid antibody syndrome (CAPS).
  • Colonoscopy confirmed a flare of underlying Crohn's disease, suggesting a potential link or exacerbation.
  • Treatment involved high-dose corticosteroids, anticoagulation, and plasma exchange, alongside initiation of azathioprine for Crohn's disease management.

Implications:

  • This case underscores the critical need for vigilance regarding APS and CAPS in Crohn's disease patients, particularly during active flares.
  • Early recognition and aggressive management of CAPS are crucial for improving outcomes in affected individuals.
  • The interplay between inflammatory bowel disease and autoimmune thrombotic disorders warrants further investigation.