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Year : 2016  |  Volume : 1  |  Issue : 2  |  Page : 60-63

A case of a venezuelan adolescent with joint complaints and inflammatory bowel disease diagnosed in cuba

1 Consultant Professor of Pediatrics, Pediatric Gastroenterologist, Pediatric Hospital “Juan Manuel Márquez”, Havana, Cuba
2 Pediatric Gastroenterologist, Department of Endoscopy, Pediatric Hospital “Juan Manuel Márquez”, Havana, Cuba
3 Anesthesiologist, Pediatric Hospital “Juan Manuel Márquez”, Havana, Cuba
4 Pathologist, Pediatric Hospital “Juan Manuel Márquez”, Havana, Cuba

Correspondence Address:
Eduardo Sagaro
Consultant Professor of Pediatrics, Pediatric Gastroenterologist, Pediatric Hospital “Juan Manuel Márquez”, Havana
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Source of Support: None, Conflict of Interest: None

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Crohn’s disease and ulcerative colitis have become increasingly common in recent years, including in children and young people. Atypical symptoms may occur in both conditions: these include isolated impairment of linear growth or presentation with extra-intestinal manifestations. Inflammatory bowel disease (IBD) is not a frequent cause of bleeding in Cuba and the Caribbean. 15 years ago we published another case of IBD in Cuban infant with Crohn’s disease, Amebiasis and Shigellosis.1 At that time, our aim was to increase the awareness among pediatricians that CD can affect all age groups. The epidemiology of IBD in the Caribbean has not been well studied and the disease has not been well described in infants and young children. Now we alert pediatricians in the area of the Caribbean and other developing countries to be aware of red flags that suggest IBD such as growth failure or slowed growth, weight loss, bleeding and extra intestinal signs. Another aim is to avoid misdiagnosis in a clinical setting in which intestinal infections are endemic. We also emphasize the need to maintain clinical suspicion and diagnose IBD before complications set in. The patient from Venezuela 2 years ago had a fall and hit himself in the right knee with inflammation of the cartilage that did not improve with orthopedic treatment. He had a progressive loss of his capacity to walk. He had a second fall with a fracture of the right wrist. A biopsy of the right knee and wrist showed synovitis, He started with bloody diarrhea in number of 15 to 20 a day of small volume accompanied with abdominal cramps. He also had pain in the elbows, knees, ankles and hips without local signs of inflammation. Weight 54 Kg. Hemoglobin 11 gr.; Hematocrit 28; Sedimentation rate 110; C-Reactive Protein 35.7; Total protein 70.6 gr/l; Albumin 31 gr/l. At Colonoscopy he had multiple deep ulcers with inflammation at the border. In the biopsy, erosion of the epithelium, branching and distortion of the glands with crypt abscesses. Pediatricians should be aware of the emergence of Crohn’s Disease in the Caribbean population. Failure to make a diagnosis may impact on their growth and development. IBD should be suspected in the presence of red flags. Sometimes is very difficult to classify the disease as CD or UC.

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