Abstract:
ABSTRACT
Introduction. Inflammatory bowel diseases (IBD) are chronic inflammatory
disorders of the gastrointestinal tract, with a steadily increasing incidence in the
pediatric population. Early diagnosis of Crohn’s disease remains challenging because
initial clinical manifestations are often nonspecific and may mimic other gastrointestinal
conditions. Delayed diagnosis may lead to progression of intestinal inflammation,
nutritional impairment, and disease-related complications. The aim of this case report
was to highlight the diagnostic pathway leading to the confirmation of pediatric-onset
Crohn’s disease and to evaluate the early response to biological therapy.
Materials and Methods. We analyzed the case of an 11-year-old boy admitted to
the Pediatric Gastroenterology Department with chronic abdominal pain, poor appetite,
rectal bleeding, iron-deficiency anemia, and persistent inflammatory syndrome.
Diagnostic evaluation was performed according to ESPGHAN recommendations and
included detailed medical history, physical examination, laboratory investigations, fecal
calprotectin measurement, immunological profiling for inflammatory bowel disease,
upper gastrointestinal endoscopy, ileocolonoscopy with biopsies, and histopathological
assessment. Clinical, laboratory, immunological, and endoscopic findings were
integrated to establish the final diagnosis and therapeutic strategy.
Results. The patient had a 3–4-month history of recurrent abdominal pain,
decreased appetite, pallor, and blood-streaked stools. Physical examination revealed an
asthenic constitution (BMI 16.7 kg/m²), periumbilical and left lower quadrant abdominal
tenderness, and clinical signs of anemia. Laboratory investigations demonstrated
microcytic hypochromic anemia (hemoglobin 101 g/L), severe iron deficiency (serum
iron 2.3 μmol/L), elevated erythrocyte sedimentation rate (up to 59 mm/h), increased Creactive
protein levels, and elevated interleukin-6 (7.2 pg/mL), indicating active
systemic inflammation. Fecal calprotectin was positive. Immunological testing revealed
positive anti-Saccharomyces cerevisiae antibodies (ASCA IgA), whereas pANCA,
cANCA, and other autoimmune markers were negative. Ileocolonoscopy demonstrated
active terminal ileitis characterized by mucosal congestion, marked granular
hyperplasia, superficial ulcerative lesions, and pronounced mucosal friability, without
extensive colonic involvement. Upper gastrointestinal endoscopy revealed erosive reflux
gastropathy, erythematous duodenopathy, and grade I reflux esophagopathy. Stool
examinations for intestinal parasites were negative. Based on the clinical, laboratory, immunological, and endoscopic findings, a diagnosis of ileal Crohn’s disease with
moderate-to-severe inflammatory activity was established. Considering disease severity
and the risk of progression, induction therapy with golimumab (100 mg) was initiated.
At the two-week follow-up assessment, the patient achieved early clinical remission,
characterized by complete resolution of abdominal pain, normalization of appetite,
improvement in general condition, and a weight gain of approximately 2 kg, with good
treatment tolerance.
Conclusions. Pediatric Crohn’s disease may initially present with nonspecific
clinical manifestations and persistent inflammatory abnormalities, contributing to
diagnostic delay. The combination of iron-deficiency anemia, systemic inflammation,
positive ASCA serology, and active terminal ileitis enabled early diagnostic
confirmation. Ileocolonoscopy with terminal ileum assessment remains the cornerstone
investigation for establishing the diagnosis. Early initiation of biological therapy was
associated with rapid clinical improvement and nutritional recovery, underscoring the
importance of prompt diagnosis and a multidisciplinary approach in the management of
pediatric Crohn’s disease.
