Extract

Learning Objectives

After completing this IBD LIVE-CME activity, physicians should be better able to:

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Presentation

Dr. Whitney M. Sunseri: Pediatric Gastroenterology Fellow I, 2014 to 2015.

The patient is an 8-year-old boy who was diagnosed with Crohn's disease in March 2013 at 6 years of age. He initially presented with a 2-month history of abdominal pain, diarrhea, vomiting, and a rash that was diagnosed clinically as erythema nodosum. His family history is positive for a maternal half-brother with early-onset Crohn's disease diagnosed at age 3 that is well controlled with infliximab. He also has an uncle with autoimmune hepatitis.

His initial esophagogastroduodenoscopy in April 2013 showed multiple aphthous ulcers in the middle and lower third of the esophagus and erythematous mucosa in the antrum, cardia, and fundus of the stomach with exudates in the antrum. The duodenal bulb and second portion of the duodenum appeared normal. Colonoscopy showed aphthae and exudate throughout the entire colon and edematous mucosa and exudates in the terminal ileum. Pathology revealed esophagitis with a submucosal epithelioid granuloma, active chronic gastritis, mildly increased intraepithelial lymphocytes in the duodenal epithelium, active chronic ileitis, and active chronic colitis throughout the entire colon including the rectum.

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