A Six-year-old Girl with Bloody Diarrhea due to a Rare Cause

Abstract

A previously healthy, six-year-old girl presented with a two-month history of bloody diarrhea, associated with abdominal pain, anorexia, weight loss, and intermittent fever. She had not traveled recently and reported no contact with sick people or exposure to animals. Physical examination revealed a well-looking child with mild conjunctival pallor. Abdominal examination revealed tenderness in the left iliac fossa with no palpable mass or organomegaly. A perianal examination was declined. Colonoscopy demonstrated severe ulcerating rectal mucosa with fungated lesions extending into the sigmoid colon. Histological analysis of rectal biopsy revealed distorted crypt architecture with crypt branching and increased inflammatory cells, mostly eosinophils. The clinical, biochemical, and histological findings were suggestive of inflammatory bowel disease (IBD). Consequently, the patient was initiated on a regimen of 5-aminosalicylic acid and oral prednisolone (1 mg/kg/day). However, her condition worsened, and she developed a fever with severe perianal pruritus and pain. Therefore, her immunosuppressive therapy was escalated to intravenous methylprednisolone, mercaptopurine (6-MP), and infliximab. She also received intravenous metronidazole and cefuroxime.

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