S3984 Cronkhite–Canada Syndrome, a Diagnosis Challenge and Management With Vedolizumab
Bibliographic record
Abstract
Introduction: Cronkhite–Canada syndrome (CCS) is a rare, nonhereditary gastrointestinal (GI) polyposis syndrome characterized by diffuse polyps, diarrhea, malnutrition, and ectodermal symptoms. There is no single confirmatory test for CCS; rather, the diagnosis is based on a combination of clinical, laboratory, endoscopic, radiologic, and histopathologic findings. Here we present a case of CCS that was initially thought to be Crohn’s disease, managed with vedolizumab for lower GI symptoms, and ultimately required total parenteral nutrition (TPN ) due to severe malnutrition. Case Description/Methods: A 65-year-old man presented with 2 months of progressive watery diarrhea (10 episodes per day), 25 lb weight loss, early satiety, and postprandial abdominal pain. He reported a persistent “greasy, foul” taste and new-onset nail dystrophy affecting all digits. He had a positive Cologuard test, and fecal calprotectin was elevated at 2,160. Abdominal computed tomography (CT) showed mild wall thickening in the descending colon. Colonoscopy revealed cobblestoning and nodular mucosa from the terminal ileum to the rectum. Histology showed chronic inflammation with eosinophilia. Diagnosed with Crohn’s disease, he was started on prednisone and vedolizumab, with initial symptom improvement and weight gain. However, by month 8, he developed worsening anorexia, dysgeusia, and weight loss. His diarrhea had improved to 3-4 times per day. Despite an increase in vedolizumab frequency, the symptoms persisted. Follow-up EGD showed large nodular gastric and duodenal polyps. Biopsies revealed epithelial hyperplasia and mucosal edema. Colonoscopy confirmed widespread inflammatory polyps with rectal sparing. In a multidisciplinary review with input from GI, pathology, radiology, and colorectal surgery, the clinical picture was deemed more consistent with CCS rather than Crohn’s disease. Vedolizumab was continued due to partial symptomatic relief. Endoscopic or surgical gastrostomy was deferred due to extensive gastric involvement and malnutrition. He was hospitalized for anasarca and hypoalbuminemia (albumin 2.3 g/dL), and initiated on TPN. Discussion: This case highlights the diagnostic complexity and clinical severity of CCS that can closely mimic Inflammatory Bowel Disease. Despite a partial response to vedolizumab, the progression of the disease led to severe malnutrition requiring TPN. Early recognition and multidisciplinary management are critical in CCS to avoid complications and improve outcomes in this debilitating condition.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".