Leukocytoclastic Vasculitis and Myositis as Initial Manifestations of Crohn’s Disease

Abstract

Crohn's disease is a chronic inflammatory condition that mainly affects the digestive tract; however, it possesses extra-intestinal manifestations. We present a case of a 19-year-old male with a history of nonspecific gastrointestinal (GI) symptoms of nausea, vomiting, and diarrhea who underwent a colonoscopy with a biopsy due to worsening GI symptoms. The colonoscopy was inconclusive for GI pathology. Three months later, he developed several symptoms, which were later indicative of leukocytoclastic vasculitis and myositis as extra-intestinal manifestations of Crohn's disease. The patient was started on high-dose prednisolone, which improved his symptoms remarkably, and the steroid dose was tapered gradually. He was subsequently followed up by the Rheumatology and Gastroenterology outpatient departments. The case reinforces the need for physicians to have a high index of suspicion in patients with non-specific GI symptoms presenting with new-onset cutaneous manifestations and myositis.

Diagnostic value of apparent diffusion coefficient of psoas muscles for evaluating complications in patients with Crohn’s disease

“…in 2022, including 2085 patients with polymyositis (PM) and dermatomyositis (DM) and 10,193 patients as a control group, demonstrated the incidence of IBD in PM/DM patients to be significantly higher (OR = 1.73, 95% CI: 1.05–2.86) [ 9 ]. Its results, such as reported clinical cases of the appearance of ocular or gastrocnemius myositis in CD patients, confirm the hypothesis of a crucial role of low-grade systemic inflammation in the disturbance of skeletal muscle homeostasis leading to sarcopaenia [ 10 – 13 ].…”

“…Penetrating disease, perianal or foregut involvement, young age at the time of diagnosis (< 40 years), smoking, and early start of corticosteroid therapy have been identified as high-risk features for required surgery (risk ratio (RR) 13.67, 95% confidence interval (CI) 1.88-99.41) and hospitalization (RR = 1.86, 95% CI: 0.03-0.43) [5]. In a recent systemic review by Tang et al in 2023, body composition parameters were shown to predict poor outcomes for CD patients [6].…”