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Pregnancy-Onset Ulcerative Colitis in a Pediatric Patient Presenting With Altered Mental Status and Severe Anemia
Alda Huang1, Gregory L Stone2, Brian Gordon3
1Department of Combined Internal Medicine and Pediatrics, Los Angeles County University of Southern California Medical Center, Los Angeles, USA.
Insights
A rare case of ulcerative colitis (UC) in a pregnant teen highlights diagnostic challenges. Early diagnosis and treatment of pregnancy-onset inflammatory bowel disease (IBD) are crucial for positive outcomes.
Area of Science:
- Gastroenterology
- Maternal-Fetal Medicine
- Pediatric Gastroenterology
Background:
- Ulcerative colitis (UC) typically presents with gastrointestinal symptoms but can manifest atypically in specific populations.
- Pediatric and pregnant patients may present unique diagnostic challenges for UC.
- Inflammatory bowel disease (IBD) diagnosis during pregnancy requires careful consideration.
Observation:
- A 16-year-old primigravida at 18 weeks gestation presented with altered mental status and severe anemia.
- Hematochezia developed post-admission, prompting an extensive diagnostic workup.
- The patient was diagnosed with UC via endoscopic and histopathologic examination.
Findings:
- High-dose steroids and infliximab induced prenatal remission of UC.
- The pregnancy was complicated by severe preeclampsia.
- The infant experienced a medically complex post-delivery course due to unrelated factors.
Implications:
- Pregnancy-onset IBD in adolescents is uncommon yet clinically significant.
- Prompt diagnosis, tailored treatment, and comprehensive counseling are essential.
- Effective management can lead to outcomes comparable to non-IBD patients.
Abstract:
Ulcerative colitis (UC) classically presents with abdominal pain, hematochezia, or diarrhea. However, it can present atypically in pediatric and pregnant patients, posing a diagnostic challenge. A healthy, 16-year-old primigravida presented at 18 weeks and six days of gestation with sudden-onset altered mental status and severe anemia. Hematochezia began about 12 hours after admission. She underwent extensive workup, leading to an endoscopic and histopathologic diagnosis of UC, and achieved prenatal remission with high-dose steroids and infliximab. Her pregnancy, however, was complicated by severe preeclampsia, and her child's post-delivery course was medically complex from an unrelated etiology. Pregnancy-onset inflammatory bowel disease (IBD) in the pediatric population is an uncommon but important consideration. Early diagnosis, treatment, and counseling are vital to achieve results comparable to those of patients without IBD.
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