Cachexia, chorea, and pain in chronic nonbacterial osteitis and inflammatory bowel disease: a case report

Journal of Medical Case Reports

Case Report

Weina Chen¹  Jason Y. Park¹  Veena Rajaram¹  Jeff L. Waugh²  Annette L. Medina³  Bhaskar Gurram⁴  Ladan Agharokh⁵  Katherine Mamola⁶  Andrew G. Yu⁶  Matthew R. Hammer⁷  Julie Fuller⁸ 

[1] Department of Pathology, University of Texas-Southwestern Medical Center, Dallas, TX, USA;Division of Child Neurology, Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA;Division of Pediatric Gastroenterology, Department of Pediatrics, Nicklaus Children’s Hospital, Miami, FL, USA;Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA;Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas Health Science Center at Houston, 6431 Fannin St., Suite JJL 210-D, 77030, Houston, TX, USA;Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA;Division of Pediatric Radiology, Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX, USA;Division of Pediatric Rheumatology, Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA;

关键词: Inflammatory bowel disease;    Chronic nonbacterial osteomyelitis;    Chorea;    Extraintestinal manifestations;   

DOI  :  10.1186/s13256-023-03894-1

 received in 2021-08-12, accepted in 2023-03-17,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundInflammatory bowel disease is an inflammatory disorder that primarily impacts the gastrointestinal tract, leading to malnutrition and chronic microscopic intestinal blood loss. Uncontrolled systemic inflammation can impact other parts of the body, known as extraintestinal manifestations. Up to 25% of patients with inflammatory bowel disease are reported to have these complications in their skin, joints, bones, eyes, liver, lung, and pancreas (Rogler et al. in Gastroenterology 161(4):1118–1132, 2021). Neurologic involvement as extraintestinal manifestations are less common, reported at 3–19%, including neuropathies, demyelination, and cerebrovascular events (Morís in World J Gastroenterol. 20(5):1228–1237, 2014).Case presentationA 13-year-old Caucasian boy presented with 1 month of progressive lower-extremity pain, weakness, and weight loss. His physical examination was notable for cachexia, lower-extremity weakness, and chorea. Labs revealed normocytic anemia and systemic inflammation. Imaging revealed symmetric abnormal marrow signal in the pelvis and upper femurs. Pathologic examination of the bone revealed chronic inflammation consistent with chronic nonbacterial osteitis. Endoscopy revealed colonic inflammation consistent with inflammatory bowel disease.ConclusionsChildren and adolescents with musculoskeletal pain lasting more than 2 weeks with systemic signs or symptoms like weight loss should prompt evaluation for systemic inflammatory disorders such as chronic nonbacterial osteitis, which can occur in isolation or associated with inflammatory bowel disease. This patient also had a nonspecific neurologic abnormality, chorea, which resolved with treatment of underlying inflammatory disorder. These extraintestinal manifestations may be concurrent with or precede intestinal inflammation, requiring a high index of suspicion when investigating nonspecific systemic inflammation.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 1

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