Case history
Case history #1
A 25-year-old white man presents to his general practitioner with cramping abdominal pain for 2 days. He reports having loose stools and losing 6.8 kg over a 3-month duration. He also reports increased fatigue. On physical examination, his temperature is 37.6°C (99.6°F). Other vital signs are within normal limits. Abdomen is soft with normal bowel sounds and moderate tenderness in the right lower quadrant, without guarding or rigidity. Rectal examination is normal, and the rest of the examination is unremarkable.
Case history #2
A 16-year-old girl presents to emergency care with perianal pain and discharge. She reports a 2-year history of intermittent bloody diarrhoea with nocturnal symptoms. On examination, she is apyrexial with normal vital signs. Her abdomen is soft and slightly tender on palpation in the left lower quadrant. Rectal examination is difficult to perform due to pain, but an area of erythematous swelling is visible close to the anal margin, discharging watery pus from its apex. Several anal tags are also present.
Other presentations
Atypical presentations depend on sites of inflammation and extra-intestinal manifestations: musculoskeletal (arthritis, polymyositis); skin (fissures, fistulae, erythema nodosum, pyoderma gangrenosum, 'metastatic Crohn's disease'); hepatobiliary (primary sclerosing cholangitis, bile duct carcinoma, autoimmune hepatitis, pericholangitis, gallstones); pancreatic (acute pancreatitis); ocular (anterior uveitis, episcleritis, scleromalacia, corneal ulcers, retinal vascular disease); blood (anaemia, thrombocythaemia secondary to inflammation, thrombocytopenic purpura); renal (urinary calculi, amyloidosis); neurological (peripheral neuropathy, myelopathy, myasthenia gravis); bronchopulmonary (pulmonary fibrosis, bronchitis, laryngotracheitis); cardiac (pericarditis, myocarditis); hypercoagulability (thrombophlebitis, thromboembolism, vasculitis); thyroid (Hashimoto's thyroiditis).[4][5][6][7][8][9]
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