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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.

ACG Case Reports Journal
|July 10, 2015
PubMed

Insights

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.

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.

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