Shruthi Sethuraman, MD1, Jeffrey Dueker, MD, MPH2 1University of Pittsburgh, Pittsburgh, PA; 2University of Pittsburgh Medical Center, Pittsburgh, PA
Introduction: Behcet’s disease is a relapsing and chronic multi-system inflammatory disease characterized by oral and genital ulcerations, arthritis, vasculitis, and can have gastrointestinal manifestations. We present a case of delayed diagnosis of colonic Behcets, initially diagnosed as infectious colitis and then as a functional GI disorder before final diagnosis.
Case Description/Methods: A 38-year-old female with a history significant for Grave’s disease, generalized anxiety disorder, and prior cholecystectomy (CCY) reported 2 years of episodic diarrhea and abdominal pain. She also has a history of oral and genital ulcerations which resolve spontaneously since the age of 16. She received several CT scans revealing colitis, however two subsequent ileocolonic endoscopic exams performed several months after symptomatic presentations were normal. She previously was treated for positive stool culture for Salmonella, also treated empirically several times with antibiotic courses. She was also diagnosed with recurrent Clostridioides difficile colitis and treated with multiple rounds of vancomycin. Eventually she was again hospitalized for symptoms of 8-10 bowel movements per day with lower abdominal pain. CT scan revealed pancolitis, and notably her erythrocyte sedimentation rate was >130 mm/hr and C reactive protein 32.7 mg/dL.
She underwent colonoscopy, this time during an episode of symptoms, revealing innumerable superficial ulcers in the entire colon, but also some larger 1 cm ulcerations with heaped up edges, with a right > left colonic distribution. Pathology demonstrated acute and chronic inflammation and areas of vasculitis involving small blood vessels, and together with her other symptoms, most suggestive of Behcet’s disease with colonic involvement. She improved rapidly with intravenous steroids, discharged home on an oral steroid taper, and subsequently started on infliximab as an outpatient, and has done well without recurrent episodes.
Discussion: A colonoscopy performed during a symptomatic episode made the definitive endoscopic and pathologic diagnosis. One defining feature of colonic Behcets are large, round, discrete, punched-out ulcers most seen in a focal distribution, oftentimes the ileocecal region. Recurrence rates are higher in intestinal BD and patients often require increased surgical intervention so swift diagnosis with treatment initiation is key.
Disclosures:
Shruthi Sethuraman indicated no relevant financial relationships.
Jeffrey Dueker indicated no relevant financial relationships.
Shruthi Sethuraman, MD1, Jeffrey Dueker, MD, MPH2. P0286 - "Disappearing Colitis" Eventually Diagnosed as Colonic Behcet’s, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
