A 20-year-old woman, born in Morocco and residing in Spain for 2 years.
The patient's personal history included unstudied chronic diarrhea and one delivery eight months prior to admission.
She was treated with oral contraceptives (Etinyl-Estradiol 75 mg/day) two years before delivery and was restarted after delivery.
She has a sister resident in Italy recently diagnosed with Crohn's disease.
The patient was admitted to our service with fever, abdominal pain and bloody diarrhea for one week.
Physical examination revealed a temperature of 38.7 oC and pain upon palpation of the left iliac fossa.
Forty-eight hours after admission, the patient progressively increased waist circumference with dyspnea.
A chest X-ray showed bilateral pleural effusion.
Abdominal X-ray showed no relevant pathological findings.
Abdominal ultrasound is reported as a large amount of ascitic fluid, bilateral pleural effusion and diffuse thickening of the colon walls.
The toraco-abdominal-pelvic computed tomography confirms the bilateral pleural effusion and also shows bilateral pulmonary thromboembolism, an increase in the hepatic caudal lobe, suprahepatic patched areas of the liver and thrombosis of the right vein.
Echocardiography ruled out heart disease.
When performed, rectal ulcers and edematous sigma and mucosa appear in the entire colon, being less intense in the ascending colon, findings suggesting Crohn's disease.
Histopathology is compatible with endoscopic findings.
Analytically the first days have changes with haemoglobin 8.4 g/dl, platelets 80,000 U/l, leukocytes 16,500 U/l with 80% neutrophils, prothrombin activity of 47%, GOT 30 mm/l
Albumin 2.4 g/dl, total protein 5.4 g/dl, CRP 13.4 mg/dl. ASLO, RF and normal iron metabolism, negative hemocultive and coprocultive.
Serological study of HBV, HCV, HIV, toxoplasma, LUES, hydatidosis and Coxiella was negative, while IgG were positive for HAV, CMV and EBV.
Antiglycoprotein antibody values were: gASCA, ALCA and AMCA negative with positive ACCA.
It is therefore a young woman with Crohn's disease, bilateral pulmonary thromboembolism and Budd-Chiari syndrome who presents as risk factors a recent pregnancy, consumption of oral contraceptives and inflammatory bowel disease not diagnosed.
Total parenteral nutrition was started, consisting of two medications, methylprednisolone, fixed-dose anticoagulants, furopenem, and low-molecular-weight heparin administered at doses associated with transfusions.
The evolution was favorable, fever, abdominal pain and diarrhea.
Ascites has been controlled with diuretics.
At discharge the patient is asymptomatic and analytically stable.
