SHM Converge Scientific Abstract ePoster Gallery-Wobbles and Groans: Neurology, Rheumatology, or Something Else?

Pdf Summary

This case describes a 7-year-old boy with 8 months of progressive knee, hip, buttock, and back pain, especially worse in the morning, causing difficulty getting out of bed. He was initially referred to physical therapy, but symptoms worsened. Neurologic evaluation, including MRI of the brain and spine, EMG, and genetic testing, was normal, so he was later seen by rheumatology.<br /><br />At that visit, new symptoms were discovered: 1 month of watery diarrhea about five times daily, nighttime awakenings, and a 3-pound weight loss. Physical exam showed a thin-appearing child with mild abdominal tenderness, bilateral lower-extremity weakness, an abnormal gait, and reduced right hip function. Labs revealed elevated inflammatory markers, and stool testing was negative for infection but showed markedly elevated fecal calprotectin.<br /><br />MRI demonstrated bilateral sacroiliitis, left knee effusion with synovitis, left femoral head edema, and small pelvic fluid. Although endoscopy and colonoscopy looked grossly normal, pathology showed inflammation throughout the gastrointestinal tract, including terminal ileitis, mild colitis, rectal inflammation, and upper GI involvement. He was diagnosed with Crohn’s disease and started on infliximab.<br /><br />The report highlights that inflammatory bowel disease can present first with extraintestinal manifestations, especially musculoskeletal symptoms such as sacroiliitis, even before obvious gastrointestinal complaints appear. This case emphasizes the importance of considering IBD in children with unexplained arthritis, back pain, or gait changes, even when initial GI symptoms are absent.

Asset Subtitle

Lucas C. Fornefeld

Meta Tag

Author List Anna Kushnir, Lucas C. Fornefeld

Category Clinical Vignettes

Concept Inflammatory Bowel Disease

Concept Sacroiliitis

Concept Fecal Calprotectin

Concept Inflammation

Concept Extra-pancreatic manifestation

Distinguished Non-Finalist

Presenter Organization Creighton University School of Medicine

Presenting Author Lucas C. Fornefeld

Track Pediatric

Keywords

Crohn's disease

inflammatory bowel disease

sacroiliitis

pediatric arthritis

extraintestinal manifestations

fecal calprotectin

terminal ileitis

synovitis

back pain

infliximab

Inflammatory Bowel Disease

Sacroiliitis

Fecal Calprotectin

Inflammation

Extra-pancreatic manifestation