P062 Crohn's disease presenting as fever of unknown origin in a six-year-old male
Notice bibliographique
Résumé
BACKGROUND: Inflammatory Bowel Diseases (IBD) are rising in incidence in the pediatric population. While most present classically, some have limited findings. We present a case of pediatric Crohn's Disease (CD) diagnosed during a fever of unknown origin (FUO) evaluation. We aim to stress the importance of uncommon presentations of a diagnosis with significant implications and requiring prompt intervention. CASE: A 6-year-old male presented with 2 weeks of evening 104–106 F fevers, weakness, decreased intake, and weight loss. He also had one loose, non-mucous, non-bloody stool daily. Fevers failed to resolve with outpatient courses of antibiotics and CRP continued to rise. History revealed camping in North Carolina 2 weeks preceding symptom onset. Family history was unremarkable. No further symptoms, including abdominal pain, were elicited. Exam exhibited fever, tachycardia, tachypnea, uvular and palatal ulcers, dry mucous membranes, cervical, submandibular and inguinal lymphadenopathy. No skin, eye, joint, perianal or abdominal findings observed. Preliminary labs showed hypoalbuminemia (2.6), elevated CRP (7.4) and ESR (55), mild leukocytosis (14.9), and microcytic anemia (Hgb 10.1, MCV 71.8). An extensive FUO evaluation failed to identify a source and thus imaging was pursued. CT abdomen/pelvis showed terminal ileitis and free fluid along the right paracolic gutter and right hepatic margin. Endoscopic evaluation for IBD discovered esophagitis along with ulcerations, edema and friable mucosa in the terminal ileum. Pathology was significant for active chronic lymphoplasmacytic gastritis with eosinophils and subtle early granulomatous inflammation with multinucleated giant cells. Distal esophagus showed chronically active inflammation and lymphocytic esophagitis without granulomas. Terminal ileum biopsy revealed active, chronic granulomatous ileitis with ulceration and granulation. No organisms noted throughout. He was diagnosed with CD and initiated on steroids along with Mesalamine. DISCUSSION: One quarter of IBD is diagnosed by the age of 20, with 4% presenting before 5 and 18% before 10 years of age. Recent incidence reports show combined U.S. and Canadian data of 10 per 100,000. Prevalence in the U.S. alone is 100–200 per 100,000. Furthermore, IBD in those less than ten is becoming more common. With recent therapeutic advances, significant morbidity and mortality is preventable. However, treatment delays occur from a diagnostic lag in 20% when symptoms are ambiguous. This case highlights early onset IBD and brings attention to non-classic presentations. Our patient was diagnosed 1.5 months after initial symptoms. An average diagnosis lag time of about 3.4 months in pediatric CD has been documented, with further delay if pre-existing gastrointestinal symptoms exist (26 months). Whereas CD is considered when abdominal pain, diarrhea, and weight loss are identified, our patient presented with daily fever along with oral lesions, lymphadenopathy and weight loss. A few case reports cite FUO, another difficult and often unclear diagnosis, as the presentation for IBD. Fever as the sole initial symptom for IBD occurs in 10-15% of cases. IBD is a complicated illness, especially in the pediatric population. When considering effects on growth, psychosocial development and the long-term complications, we must consider IBD in the differential of pediatric patients with vague and persistent symptoms including FUO.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».