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Kimi Sumimoto, Mitsunobu Matsushita, Takashi Okazaki, Mika Omiya, Kazushige Uchida, Kazuichi Okazaki, Crohn's disease accompanied by purulent discitis and psoas abscesses, Inflammatory Bowel Diseases, Volume 14, Issue 5, 1 May 2008, Pages 728–730, https://doi.org/10.1002/ibd.20355
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To the Editor:
Although Crohn's disease (CD) predominantly affects the gastrointestinal system, various extraintestinal manifestations have been documented.1,–3 Neurological involvement is rare, and may be coincidental or related to the basic disease or to its complications or treatment.3 We describe an extremely rare case of CD accompanied by purulent cervical discitis, which caused progressive hemiplegia. Later, the patient was also accompanied by psoas abscesses with purulent lumbar discitis.
A 70-year-old woman, who had been suffering from CD for 12 years, was referred to our hospital because of a 2-week history of fever, general fatigue, and appetite loss. Although CD was well controlled with mesalazine and nutritional support until 2 months before this admission, her compliance with the medications had been poor. Physical examination on admission showed slight tenderness at the lower abdomen without muscular guarding. Bowel sounds were normal. Laboratory data showed severe inflammation, mild anemia, and slightly poor nutrition. Computed tomography (CT) showed ileocecal wall thickening with severe inflammation. Colonoscopy showed several longitudinal ulcers with multiple cobblestone appearances in the stenotic terminal ileum. Moreover, we suspected the presence of a fistula from the terminal ileum to the ascending colon, which was confirmed with a gastrograffin enema. Small intestinal series showed no other abnormalities. Because severe ileocecal inflammation with ileocolonic fistula was disclosed, we treated her with antibiotics (imipenem/cilastatin and ciprofloxacin) and infliximab on total parenteral nutrition.
