Posted 11/29/2022 6:34 PM (GMT -8)
My son(14 yrs old) started seeing some blood in his stool without having any pain in the abdomen or having diarrhea ( 2 times poop max a day). No fever.
His symptoms lasted for a month n half and we would not see blood on a daily basis. He had some hammeroids too before he started seeing blood stained poop.
Doc did the blood work and saw high CRP, fecal calprotectin level. He didn't do any stool culture for any infection.
We were asked to go for endoscopy and colonoscopy and then biopsy. (report is as below). He did see some small individual ulcers (10-12 in terminal ileum and 3-4 in cecum and some inflammation in cecum)
After biopsy doctor confirmed that its Crohns as he could see granulomas in biospy
I have searched up a lot after that and found that you need to have certain types of granulomas to have crohns.
A: Random duodenum biopsy:
No significant/diagnostic histologic abnormalities.
No significant intraepithelial lymphocytosis.
No villous blunting.
No evidence of Giardia.
B: Stomach biopsy:
No significant/diagnostic histologic abnormalities.
No H. pylori organisms identified on HE.
No evidence of intestinal metaplasia or dysplasia.
C: Terminal ileum biopsy:
Focal active ileitis and focal crypt architectural distortion identified
adjacent to lymphoid hyperplasia.
No granulomas or dysplasia.
D: Cecum biopsy:
Focal acute ulceration.
Poorly formed granulomas identified.
Negative for dysplasia.
See comment.
E: Random colon biopsy:
No significant/diagnostic histologic abnormalities.
No granulomas.
Negative for dysplasia.
F: Rectosigmoid colon biopsy:
Focal mild active proctocolitis.
No diagnostic evidence of chronic proctocolitis.
No granulomas or dysplasia.
G: Rectum biopsy:
Focal minimal chronic active proctitis.
No granulomas.
Negative for dysplasia.
COMMENT:
The findings of ileocecal erosion/acute ulceration, focal active ileitis, focal active proctocolitis, and focal chronic proctitis raise a differential diagnosis of infectious enterocolitis, drug/toxin induced
enterocolitis, inflammatory bowel disease, and enterocolitis secondary to vasculitis/connective tissue disease, among others. Clinical correlation is recommended.
Since prominent lymphoid proliferation is noted in the terminal ileum biopsy, a battery of immunostains are performed. The lymphoid population is composed of a mixed T cells and B cells with B cells
slightly overrepresented. No coexpression of CD10 is seen on B cell population. Cyclin D1 is negative. Ki67and CD21 highlight germinal centers. No coexpression of BCL2 and BCL6 is noted. No diagnostic
evidence of lymphoma is identified immunohistochemically on the selected panel.
AFB stain and GMS stain performed on block D1 are negative for acid-fast bacilli and fungal elements, respectively. Control tissue shows appropriate staining. Since AFB stain has a low sensitivity on tissue
section, negative staining does not entirely rule out infection.
Clinical correlation is recommended.