Sistema Gastrointestinal e Digestivo

Abstrato

Early onset infantile ulcerative colitis: A rare atypical aetiology of toddler's diarrhea

Mithilesh Kumar, Dinesh Kumar, Deepak Sachan, Arvind Ahuja

Introduction: Paediatric IBD is a chronic inflammatory disease characterised with complex interaction of genetic, environmental and mucosal immune response regulating factors. Paediatric IBD has mean age of presentation of 12 years with very early IBD as a rare presentation having less than 1 % incidence. Early IBD shows predominance of incidence of CD over UC. Paediatric UC occasionally presents features of macroscopic rectal sparing.

Case report: This is case report of early IBD with atypical features of macroscopic and microscopic rectal sparing. Toddler presented with bloody diarrhoea, failure to thrive, skin rash and swollen knee. On examination baby was severely wasting with stunting, severe pallor and multiple skin lesion over leg. Bilateral knee arthritis with restriction of movement also was observed in baby. Patient was diagnosed as UC on basis of colonoscopy and histology. Absence of perianal disease, stenosis, cobble stoning, and linear ulcerations in the ileum ruled out CD. Infectious colitis, Allergy and immunodeficiency disorder most often implicated in causes of infantile colitis were differentially ruled out.

Conclusion: Infantile disease is more frequently associated with a CD-type illness, but distinguishing between CD and UC is challenging. And the diagnosis may change during subsequent follow up.