Unusual presentation of Crohn's disease

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Case Study

Background:

• Inflammatory bowel disease (IBD) can manifest with diverse extraintestinal and gastrointestinal symptoms.
• Protein-losing enteropathy (PLE) is an uncommon complication of IBD, characterized by excessive protein loss through the gastrointestinal tract.
• Serum hypoalbuminemia and edema are key clinical indicators of significant protein loss.

Observation:

• A 37-year-old woman presented with lethargy, breathlessness, and peripheral edema, initially attributed to iron deficiency anemia and hypoalbuminemia.
• Extensive investigations excluded renal, cardiac, and hepatic causes for her persistent hypoalbuminemia and edema over two years.
• Capsule endoscopy revealed small bowel ulceration, and subsequent analysis showed elevated fecal alpha-1 antitrypsin, indicating protein loss.

Findings:

• Histological diagnosis post-small bowel resection confirmed Crohn's disease as the underlying cause of the patient's symptoms.
• The clinical presentation was predominantly that of protein-losing enteropathy, a rare manifestation of Crohn's disease.
• This case underscores the importance of considering gastrointestinal causes for unexplained hypoalbuminemia and edema.

Implications:

• This case emphasizes the need to recognize protein-losing enteropathy as a potential, albeit uncommon, presentation of Crohn's disease.
• Early identification and management of PLE in Crohn's disease can prevent severe complications and improve patient outcomes.
• Further research into the pathophysiology and diagnostic challenges of PLE in IBD is warranted.