ABSTRACT
INTRODUCTION: Thrombotic events are more than twice as common in inflammatory bowel disease patients as in the general population. We report an interesting and rare case of portal vein thrombosis as a venous thromboembolic event in the context of extraintestinal manifestations of Crohn's disease. We also conducted a literature review on portal vein thrombosis associated with inflammatory bowel disease, with the following concepts: inflammatory bowel diseases, ulcerative colitis, Crohn's disease, portal vein, and thrombosis. CASE PRESENTATION: A 24-year-old Syrian female with active chronic Crohn's disease was diagnosed 11 years ago and classified as A1L3B1P according to the Montreal classification. She had no prior surgical history. Her previous medications included azathioprine and prednisolone. Her Crohn's disease activity index was 390 points. Gastroduodenoscopy revealed grade I esophageal varices, a complication of portal hypertension. Meanwhile, a colonoscopy revealed several deep ulcers in the sigmoid, rectum, and descending colon. An investigation of portal vein hypertension revealed portal vein thrombosis. We used corticosteroids to induce remission, followed by tapering; additionally she received ustekinumab to induce and maintain remission. She began on low-molecular-weight heparin for 1 week, warfarin for 3 months, and then apixaban, a novel oral anticoagulant, after excluding antiphospholipid syndrome. Primary prophylaxis for esophageal varices was not required. After 1 year, she achieved clinical, biochemical, and endoscopic remission. Despite 1 year of treatment, a computed tomography scan revealed no improvement in portal vein recanalization. CONCLUSION: Portal vein thrombosis is a rare and poorly defined complication of inflammatory bowel disease. It is usually exacerbated by inflammatory bowel disease. The symptoms are nonspecific and may mimic a flare-up of inflammatory bowel disease, making the diagnosis difficult. Portal vein Doppler ultrasound for hospital-admitted inflammatory bowel disease patients may contribute to the diagnosis and management of this complication.
Subject(s)
Anticoagulants , Crohn Disease , Portal Vein , Venous Thrombosis , Humans , Crohn Disease/complications , Female , Portal Vein/diagnostic imaging , Venous Thrombosis/etiology , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy , Young Adult , Anticoagulants/therapeutic use , Warfarin/therapeutic useSubject(s)
Antirheumatic Agents , Macrophage Activation Syndrome , Methotrexate , Humans , Methotrexate/therapeutic use , Macrophage Activation Syndrome/diagnosis , Macrophage Activation Syndrome/drug therapy , Macrophage Activation Syndrome/etiology , Antirheumatic Agents/therapeutic use , Antirheumatic Agents/adverse effects , Treatment Outcome , Still's Disease, Adult-Onset/drug therapy , Still's Disease, Adult-Onset/diagnosis , Still's Disease, Adult-Onset/immunology , Female , MaleABSTRACT
We present a case of an acquired deformity of the toes of a young patient with no previous pathologic or traumatic history. Later, it emerged that it was 'Focal Myositis' at the Flexor Digitorum Brevis muscle of the right foot. The clinical course of the case involved a hard painless mass at the muscle belly that increased in size very slowly over several years, causing flexion contracture of the third toe without an accompanying skin lesion.
