A two-year-old girl was taken to the emergency department of a tertiary hospital for presenting soft stools for 20 days, four to six a day, with abundant red blood and mucus, and pain before admission.
With no personal history of interest, her father suffered from chronic gastritis, with no other relevant family history.
Ten days before, she had come to the emergency department for the same reason, at which time her study was initiated, with blood tests (hemoglobin, 10 g/dl; microbiological platelets, 663 000/μl; normal ultrasound, ferritin
The study was completed with calprotectin in feces, serology of Epcitostein and IgA antibodies, cytomegalovirus, Campylobacter jejuni, Saccharomyces cerevisiae, human immunodeficiency virus
All these tests were normal except for calprotectin greater than 600 μg/g.
Given these findings, in this second visit to the Emergency Department, admission was decided.
Upper endoscopy showed antral gastritis and duodenitis, as well as colitis associated with nonspecific colitis.
The pathological study showed chronic active colitis compatible with idiopathic IBD suggestive of CD.
It was decided to start treatment with a pediatric table and polymeric stools and normalize within ten days, when the patient was discharged.
Twenty-four hours after discharge, the patient resumed vomiting and bloody liquid stools 10 a day, so he was admitted again.
Oral corticosteroid therapy (maximum 1.5 mg/kg/day) was added to the treatment. Pathological examination revealed a bleeding mucosa with continuous involvement of the rectum and sigmoid colon with UC and fibrin.
Given the poor clinical outcome (Pediatric Ulcerative Colitis Activity Index [PUCAI]: 65), azathioprine and infliximab treatment were added.
The stools are immediately normalized and discharged after 11 days.
