CASE REPORT

Diagnostic Problems in Crohn's

Disease: A Case Report
**
Rio Zak,aria*, Achirnad Murtiani Abclullah", Ari Fahrial Syaunt
'Department of Internal Medicine, Faculty of Medicine, University of Indonesia
Dr. Cipto Mangunkusumo General National Hospital, Jakarta
Division of Gaqtroenterolegy, Department of Internal Medicine, Faculty of Medicine
University of Inclonesianr. Cipto Mangunkusumo General National Hospital, Jakarta

ABSTRACT
Cmhn's disease is marked by transmural inflammation of the digestive tract and is categorized into
inflammatory hovel disease (IBM_ In Indonesia, Simadibrata et al, reported 20% from 107 patients who
experienced non-infrctive chronic diarrhea, actually steered from IBD.
A 33-year old male patient complained of watery stool since 3 months before hospital admission_ He
experienced stabbing stomachache and loss Ofhady weight_ Physical and laboratory examination results were within
normal limits. Faecal analysis revealed intestinal infection caused by gram-negative bacteria and intestinal maldigestion.
Colannscopy examination eithibited the presence of hyperemic mucosa, edematous, and positive cobblestone
appearance in the terminal ileum. Additionally, the histological escalation showed the impression of chronic ileitis
usually found in IBR Meanwhile, moderate pangastritis was obtained in the esophagadtiodenoscopy examination. Results
of histological biopsy of the antrum showed absence Of lielienhacter pylori infection. An active lesion in chronic ileitis
was found in ilffiffLePahivochemiNtry examination. Acid fast bacterial culture was also performed to the ileum tissue
and revealed negative results in clinical microbiology examination_ Fraltr the examinations conducted, patient was
diagnosed as Crohn %. disease and treated with budesonide capsule 3 mg and mesalazine tablet 1,000 mg twice daily
Later, he felt improvement of the complains.
This case illustrated Crohnk disease which is rarely found in Indonesia. This is because diagnosis requires
supporting examinations which could only he done in tertiary health care facilities_ However, possibility of other
diagnosis should be considered, particularly intestinal tubercidasis and infective colitis_ Early diagnosis and prompt
treatment may improve patient v.-inn:Fasts and quality of life_

Keywords: IRD, Crohn c disease, positive cobblestone

ABSTRAK

Penyakit Crohn ditandai oleh peradangan transmural .saluran pencernaan,dan dikatagorikan &dam Arial:T(3k
penyakit peradangan Una_ Di Indonesia, Simadibrata dkk, melaporkan 20% dari 107Fa.sienyangmengo lami diare
kronik non infeksi menderita penyakit peradangan tams
Pasien laki,laki nsia 33 tahun datang den gan keluhan &tang air besar (BAR) cair sejak 3 holm sebelmm
masuk rumah sakit. Pasien juga merasakan nyeri pent seperti ditusuk-tusuk dan penarunan berat badan. Dari
pemeriksaan Wasik don laharasorium &dam hams normal_ Pada analisa feses didapatkan infeksi ustes itarena
bakteri gram negailf serta maldigesii assns. Pemeriksaan kolonaskopi menunjukkan pada ileum terminal ditemukan
mmkasa hiperemis, edemataus dengan cobblestone pasitif serta dari pemeriksaan patologi anotomi
(PA) didapatkan kesan ileitis kronik yang dapat ditemukan pada peny.akit peradangan assts_ Semen tarn pada
esojagogastrodundenaskopi didapatkan pangastritis sedang. Haul biopsi PA dari annum menyatakan tidak
ditemukan Helicabacter pylori Pemeriksaan imunahistokirria menu:of-241am state lesi akirfpada ileitis kmnik_ Pada
pasien dilakukan pia pemeriksaan bakteri tahan again knitnr darn jaringan ileum di bagian mikrobiologi

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