Primary Sclerosing Cholangitis and Crohn's Disease: A Rare Association

Inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) are closely associated disease entities that, when present in combination, create a phenotypically different summative disease referred to as PSC-IBD. The hallmark of Crohn's disease is persistent inflammation that can affect any part of the gastrointestinal system, from the mouth to the anus, although the terminal ileum and proximal colon are most frequently affected. Crohn's disease can sporadically impact the duodenum and stomach. Here, we present the case of a 12-year-old child who presented with per rectal bleed, hematemesis, and persistent elevated transaminasemia. A biopsy revealed micro-granulomas from the stomach's antrum and colonic mucosa, as well as focally exacerbated colitis. For a prolonged increased cholestatic pattern of liver enzymes, we performed an autoimmune panel and magnetic retrograde cholangiopancreatography, which revealed PSC. The patient was started on steroids and immunosuppressants.