SHM Converge Scientific Abstract ePoster Gallery-CRP in Ulcerative Colitis: Piece of the Puzzle or Puzzling Piece?

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A 37-year-old woman presented with one month of severe bloody bowel movements, tenesmus, urgency, nighttime accidents, and mild weight loss. Despite symptoms suggestive of inflammatory bowel disease, her initial CBC, CMP, ESR, and CRP were normal. She had no extra-intestinal symptoms, travel history, antibiotic use, or dietary changes. Because her bleeding worsened to as many as 30 episodes per day, she was directly admitted.<br /><br />On exam, she had left lower quadrant tenderness, hyperactive bowel sounds, and bloody stool. Repeat inflammatory markers remained within normal limits and were similar to outpatient values. Further workup included fecal calprotectin, CT abdomen/pelvis, and colonoscopy.<br /><br />CT imaging showed significant inflammation in the rectosigmoid colon. Colonoscopy revealed 45 cm of Mayo 2 ulcerative colitis, and pathology showed acute colitis without chronicity. Her fecal calprotectin was markedly elevated at 3000 μg/g, later decreasing to 50 μg/g after treatment.<br /><br />She was treated with prednisone, mesalamine enemas, and oral mesalamine, with symptomatic improvement within two weeks. A future sigmoidoscopy was planned to confirm ulcerative colitis pathologically.<br /><br />The case highlights an important teaching point: normal CRP does not rule out ulcerative colitis or other IBD. CRP can be affected by medications, age, lifestyle, and genetic variation, and about 15% of healthy individuals may not mount a CRP response even during inflammation. Therefore, normal CRP should not delay endoscopic evaluation when clinical suspicion remains high, as this may worsen quality of life and postpone diagnosis.

Asset Subtitle

Anna Symmes

Meta Tag

Author List Anna Symmes, Joel Pekow, MD, Monica H. Xing

Category Clinical Vignettes

Concept Inflammatory Bowel Disease

Concept Ulcerative Colitis

Concept Bloody Stool

Concept Colonoscopy

Concept Tenesmus

Distinguished Non-Finalist

Presenter Organization The University of Chicago, Department of Medicine, Section of Hospital Medicine

Presenting Author Anna Symmes

Track Adult

Keywords

ulcerative colitis

bloody bowel movements

normal CRP

fecal calprotectin

colonoscopy

rectosigmoid inflammation

Mayo 2 colitis

tenesmus

prednisone

mesalamine

Inflammatory Bowel Disease

Ulcerative Colitis

Bloody Stool

Colonoscopy

Tenesmus