Intestinal paracoccidioidomycosis resembling Crohn's disease in a teenager: a case report.

BACKGROUND: Differential diagnosis of inflammatory bowel disease is often very challenging. Paracoccidioidomycosis is a fungal disease that can mimic manifestations of Crohn's disease. CASE PRESENTATION: We report a case of a 13-year-old Caucasian boy with abdominal pain for 1.5 years associated with nausea, diarrhea, and weight loss of 10 kg. He presented increased C-reactive protein and an increased erythrocyte sedimentation rate. A colonoscopy showed deep serpiginous ulcers throughout his entire colon and rectum, which suggested Crohn's disease. He received one dose of infliximab, which is an anti-tumor necrosis factor-α, and showed no improvement. After the second dose, he got worse and started to have bloody diarrhea. A new colonoscopy was performed and pathological examination revealed ulcerative chronic inflammation with non-caseating granulomas and fungal structures (budding forms) compatible with Paracoccidioides brasiliensis. He underwent intravenously administered and then orally administered trimethoprim-sulfamethoxazole treatment. Due to drug intolerance, he was treated with amphotericin B and itraconazole, then he showed clinical improvement and mucosal healing with good outcome. CONCLUSION: Paracoccidioidomycosis must be part of the differential diagnosis of inflammatory bowel diseases in endemic areas and must be excluded before starting immunosuppressive therapy.

Free peritoneal perforation in a patient with Crohn's disease - Report of a case.

INTRODUCTION: Bowel perforation with free peritoneal air is a rare complication of Crohn's disease (CD). PRESENTATION OF CASE: We report a case of a 36 year-old male patient, with history significant for CD and he presented to the emergency room with a free peritoneal perforation, which was diagnosed by abdominal X-ray and confirmed by CT scan. The patient underwent a laparotomy surgery; however, no site of perforation was identified. The surgical approach was to clean the cavity, close the abdominal wall and administer antibiotic therapy. He demonstrated good early and late postoperative outcomes. DISCUSSION: We report a rare case of free perforation to the peritoneum in a patient with CD. The most likely hypothesis is that it was a micro-colonic perforation. Antibiotic therapy and a conservative surgical approach without colon resection can be performed and it is reported in the literature. CONCLUSION: Emergency conditions in CD may result in significant morbidity, but are normally associated with low mortality, if identified and treated properly.