Im Board Review

Abdominal pain and bloody diarrhea in a 32-year-old woman

Neha Agrawal, MD, Amandeep Singh, MD, Thomas Plesec, MD, David Liska, MD, Bradley Confer, DO, Jessica Philpott, MD, PhD and Florian Rieder, MD
Cleveland Clinic Journal of Medicine November 2017, 84 (11) 847-854; DOI: https://doi.org/10.3949/ccjm.84a.16085

Article Figures & Data

Figures

  • FIGURE 1
    FIGURE 1

    From Lee SK, Kim BK, Kim TI, Kim WH. Differential diagnosis of intestinal Behçet’s disease and Crohn’s disease by colonoscopic findings. Endoscopy 2009; 41:9–16; copyright Georg Thieme Verlag KG.

  • FIGURE 2
    FIGURE 2

    Colonoscopy revealed multiple deep, round, confluent ulcers with a “punched-out” appearance, as well as fissures in the entire colon with normal intervening mucosa and normal terminal ileum.

Tables

  • TABLE 1

    Results of admission laboratory testing

    TestResult aReference range
    Blood cell count
    White blood cell count (× 109/L)16.653.7–11
    Neutrophils (%)69.040–80
    Lymphocytes (%)20.020–40
    Monocytes (%)11.02–10
    Eosinophils (%)0.01–6
    Basophils (%)0.0< 1–2
    Absolute neutrophil count (× 109/L)11.491.45–7.5
    Platelet count (× 109/L)524150–400
    Hematocrit (%)28.536–46
    Hemoglobin (g/dL)8.411.5–15.5
    Mean corpuscular volume (fL)71.880–100
    Mean corpuscular hemoglobin (pg/cell)21.226–34
    Mean corpuscular hemoglobin concentration (g/dL)29.530.5–36
    Red blood cell distribution width (%)20.011.5–15
    Mean platelet volume (fL)8.89.0–12.7
    Metabolic panel
    Total protein (g/dL)6.16.0–8.4
    Albumin (g/dL)2.73.5–5.0
    Alanine aminotransferase (U/L)210–45
    Alkaline phosphatase (U/L)6740–150
    Aspartate aminotransferase (U/L)217–40
    Total bilirubin (mg/dL)0.20–1.5
    Blood urea nitrogen (mg/dL)77–21
    Creatinine (mg/dL)0.630.7–1.4
    Glucose (mg/dL)12865–100
    Sodium (mmol/L)131136–144
    Potassium (mmol/L)3.23.5–5.0
    Calcium (mg/dL)8.28.5–10.5
    Chloride (mmol/L)9498–110
    Bicarbonate (mmol/L)2223–32
    Anion gap (mmol/L)150–16
    Others
    C-reactive protein (mg/dL)23.50–1
    Erythrocyte sedimentation rate (mm/hr)650–15
    Stool tests
    Stool lactoferrinPositive
    Stool cultureNegative
    Clostridium difficile toxinNegative

    • ↵a Abnormal values are shown in bold.

  • TABLE 2

    Diagnostic criteria for Behçet disease

    CriterionRequired features
    Recurrent oral ulcerationAphthous (idiopathic) ulceration, observed by the physician or patient, with at least 3 episodes in any 12-month period
    Plus any two of the following:
    Recurrent genital ulcerationAphthous ulceration or scarring, observed by the physician or patient
    Eye lesionsAnterior or posterior uveitis or cells in the vitreous on slit-lamp examination; or retinal vasculitis documented by an ophthalmologist
    Skin lesionsErythema nodosum-like lesions observed by the physician or patient
    Papulopustular skin lesions or pseudofolliculitis with characteristic acneiform nodules observed by the physician
    Pathergy testInterpreted at 24 to 48 hours by the physician
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