Thrombotic storm in inflammatory bowel disease

Abstract

Rationale: Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease (IBD) and are recognized causes of gastrointestinal diseases. Thromboembolism is known to be one of the extraintestinal complications of IBD. However, there have been no reports of a “thrombotic storm,” which is a rare form of thromboembolism, as the first manifestation of a case of previously unknown IBD. In this report, we describe a case of thrombotic storm as the initial presentation of IBD. Patient concerns: A 15-year-old girl with no known history of chronic medical illnesses presented to our clinic with complaints of infrequent loose bowel movements associated with occasional rectal bleeding 4 months prior. Diagnoses: Abdominal examination revealed tenderness upon superficial and deep palpation of the epigastrium and left lower quadrant of the abdomen. Digital rectal examination revealed no tenderness or masses in the rectal canal, but bloody stools were noted; imaging revealed extensive thrombosis. Sigmoidoscopy findings and histology were consistent with those of ulcerative colitis. Interventions: Anticoagulation therapy was initiated for the treatment of the thrombosis. Sigmoidoscopy and biopsy were also performed to ensure that an accurate diagnosis was made. The patient was placed on a therapy of methylprednisolone, mesalazine, and enoxaparin. Outcomes: During follow-up, the patient's symptoms were found to have subsided, her test results had improved, and no further flare-ups of the ulcerative colitis were noted. Lessons : This case highlights the fact that thrombosis can precede IBD and can make the accurate diagnosis of such cases more challenging. The risk of thrombus propagation also poses a challenge in such cases.