University of Puerto Rico School of Medicine San Juan, PR, United States
Gabriela A. Báez-Bravo, MD, Dahima Cintrón-López, MD, Antonio I. Del Valle-Segarra, MD University of Puerto Rico School of Medicine, San Juan, Puerto Rico
Introduction: Very-early-onset Inflammatory Bowel Disease (VEO-IBD), defined as IBD in children less than 6 years old, accounts for only 1-2% of IBD cases. Although IBD in young children is uncommon, this group is now experiencing a significant increase in its incidence. Little is known about VEO-IBD presentation and therapeutic outcomes among ethnic subgroups.
Case Description/Methods: We present the case of a 2 year-old Hispanic female, with no history of systemic illness, adequate growth, and no family history of IBD, who presents with acute onset hematochezia and diarrhea. Initial evaluation revealed leukocytosis with bandemia, negative blood and stool culture, negative ova and parasites, normal inflammatory markers, and negative Meckel Scan. Despite empiric antibiotic therapy, the patient persisted with ongoing hematochezia for 10 days, resulting in symptomatic anemia that required blood product transfusion. Abdominopelvic CT with IV and oral contrast was performed for further evaluation which revealed colitis in the rectum and sigmoid colon. A diagnostic colonoscopy was remarkable for moderate pancolitis with findings consistent with Ulcerative Colitis. The patient was started on oral 5-aminosalicylate and systemic steroid therapy which resulted in rapid improvement of symptoms.
Discussion: To our knowledge, this is the first case report of a hispanic infant diagnosed with VEO-IBD. Although presentation is usually gradual, this patient had an acute presentation that included a broad differential ranging from infectious, anatomical (Meckel's) to inflammatory bowel disease. Similar to patients with mild to moderate ulcerative colitis, our patient showed adequate response to systemic steroids and oral 5-ASA. In accordance with a small comparative study of older pediatric IBD patients of different ethnicities, our hispanic patient did not have a first degree relative with IBD and did not show failure to thrive. Hispanic pediatric patients may pose a challenge when making the diagnosis of IBD, therefore further research is needed to address how diversity drives differences in disease manifestations and outcomes.
Figure: Endoscopic findings of decreased vascular pattern, erythema, exudates and pin-point ulcers.
Gabriela A. Báez-Bravo indicated no relevant financial relationships.
Dahima Cintrón-López indicated no relevant financial relationships.
Antonio I. Del Valle-Segarra indicated no relevant financial relationships.
Gabriela A. Báez-Bravo, MD, Dahima Cintrón-López, MD, Antonio I. Del Valle-Segarra, MD. P0894 - Two-Year-Old Hispanic Female With Acute Onset Painless Hematochezia; An Unusual Presentation of Ulcerative Colitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.