INFLAMMATORY BOWEL DISEASE - CASE REPORT OF A NEWLY DIAGNOSED ELDERLY WOMAN.
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All Authors
Frade, J.S.
Simoes G.M.
Carneiro D.
Barata B.
Mesquita P.
Alves Teixeira J.
Albuquerque M.
De Sousa E.
Lalanda C.
Monteiro R.
LTHT Author
Goncalves, Rui Batista
LTHT Department
Doctors' Rotation
Non Medic
Publication Date
2022
Item Type
Conference Abstract
Language
Subject
Subject Headings
Abstract
Case Description: A 92-year-old patient was admitted due to chronic diarrhea and involuntary weight loss [>10kg]. The patient had no history of recent antibiotic therapy and was on loperamide qds with no improvement. The patient denied fever, vomiting, or diet changes. Despite the possible ferrous sulfate therapy link, its suspension proved to be ineffective. The patient was emaciated, dehydrated, and pale; had a systolic murmur and the abdominal examination was unremarkable. Clinical Hypothesis: Cancer; infectious and non-infectious gastroenteritis or colitis; diverticulosis; and inflammatory bowel disease [IBD]; Crohn's disease [CD] or ulcerative colitis [UC]. Diagnostic Pathways: Microbiology findings were unremarkable; positive fecal calprotectin; initial CT revealed nonspecific parietal thickening of the large rectal ampulla, though rarefaction of the colonic haustrations was found on 3 months re-evaluation; edema and hyperemia of the descending and sigmoid colon on colonoscopy; upper endoscopy uncovered reddish and swollen mucosa of the gastric body and antrum; and stomach and duodenum biopsies were highly suggestive of CD due to aspects corresponding to gastric involvement. Discussion and Learning Points: According to findings, CD was the most likely diagnosis, and the patient was started on budesonide with total remission. Nonetheless, the next steps remain challenging, weighing the maintenance of the corticoid therapy on a low dose or whether to adopt a watchful waiting strategy or even to switch to azathioprine or biological agents [vedolizumab]. The importance of a thorough investigation is fundamental since IBD can present in different ways, at any age - approximately 1:160 elderly individuals is affected by IBD.
Journal
European Journal of Case Reports in Internal Medicine