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A 26-year-old man of East Asian origin, who migrated to Australia aged 15, presented with a 12-month history of epigastric and lower abdominal pain, weight loss of 5 kg in 2 months, mild constipation and night sweats. He reported recurrent mouth and pharyngeal ulcers since childhood. His grandfather suffered from pulmonary tuberculosis, with whom he lived in his early childhood. On examination, he had tenderness in the right iliac fossa with no mass, and a nodular rash on his thigh.
Blood tests showed elevated C reactive protein of 56 mg/L and normal full blood count, electrolytes, liver biochemistry, iron and B12 stores. HLA-B51 and interferon gamma release assay for Mycobacterium tuberculosis were negative. Faecal calprotectin was elevated at 583 µg/g. CT of the abdomen and pelvis revealed bowel wall thickening in the caecum and ascending colon with mesenteric lymphadenopathy (figure 1A). A gastroscopy showed …
Contributors MC: writing and drafting the article, critical appraisal and final approval of the manuscript. JDS: critical appraisal and final approval of the manuscript. PB and TRS: acquisition of biopsy image, appraisal and final approval of the manuscript. MG: conception of report, acquisition of data, writing and drafting the article, critical appraisal and final approval of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests MC and PB: none. JDS: support for attending meetings: Pfizer for virtual conference fees. TRS: paid lectures and workshops for Bayer and Siemens. MG: grants or contracts: Pharmacosmos, Janssen and Celltrion, consulting fees: Pfizer and Pharmacosmos, payment of lectures and presentations: Dr Falk, Abbvie, Pharmacosmos, Pfizer and Janssen and support for attending meetings: Pharmacosmos, Pfizer, Abbvie and Janssen.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.