P179 ELEVEN-YEAR-OLD WITH INFLAMMATORY THORACIC ANEURYSM FOUND AT DIAGNOSIS OF CROHN'S DISEASE. (18th January 2018)

• Record Type: Journal Article
• Authors: Talathi, Saurabh; Mannion, Melissa; Colvin, Edward; Beck, Adam; Dabal, Robert; Maclin, Jeanine; Dimmitt, Reed; Jester, Traci
• Is Part Of: Inflammatory bowel diseases. Volume 24(2018)Supplement 1
• Page Start: S67
• Page End: S68
• Publication Date: 2018-01-18
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izy038.011
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Introduction: Cardiovascular associations of Crohn's Disease (CD) are rare and include valvular heart disease, aortitis and aneurysm. We report an 11 year old with thoracic aortitis and aneurysm found during initial presentation of CD. Presentation: An 11 year old African American female presented with symptoms concerning for inflammatory bowel disease. Work up revealed leukocytosis, and serum evidence of inflammation. Imaging showed thickening of the distal ileum, suggestive of CD. Surprisingly an aneurysm involving the descending thoracic aorta, with wall thickening, concerning for an impending rupture was also found which was confirmed on an angiogram. Subsequent endoscopy revealed ileocolitis; with no evidence of vasculitis. She was started on infliximab and methotrexate. An elective repair with reconstruction of the aneurysm was performed. The resected aorta revealed neutrophilic infiltrate consistent with inflammation. Work up for primary vasculitis was unrevealing. Her symptoms improved and laboratory markers on the current therapy. Discussion: Prevalence of EIMs in CD ranges from 10% to 50%. Cardiovascular associations in CD are rare. Adult patients with long standing history of CD may rarely develop aortitis, however, presence of aortitis at diagnosis of CD is not yet reported. Noninfectious aortitis can be managed with steroids, immunosuppressants or surgery. Given the findings of the aneurysm, we performed an elective surgical repair. We chose to avoid steroids because of limited complaints related to her disease and to limit her risk of infection during her upcoming surgery. Conclusion: IBD and aortitis can present simultaneously, especially CD. Concomitance of IBD and aortitis is most likely to be related, than a mere coincidence. Aortitis with limited symptoms can be managed with infliximab and methotrexate without the use of high dose steroids.