2047 Insidious Onset of Crohn's Disease During Pregnancy

INTRODUCTION: Inflammatory bowel disease (IBD) affects 1.3 million people in the United States. The typical age of onset is at 15-30 years, thus affecting women during their childbearing years. Symptoms can often be mistaken for other conditions, especially in pregnant individuals. This case shows an interesting presentation of IBD occurring immediately after childbirth. CASE DESCRIPTION/METHODS: A 21-year-old female with no significant past medical history presented to the ER with GI discomfort and diarrhea. Her symptoms began 1 month prior, immediately after an uneventful vaginal delivery of her first child. She developed abdominal pain and cramping, which she was initially told was normal after her delivery. However this persisted and she also developed diarrhea with 5-7 loose bowel movements per day, hematochezia, as well as inability to tolerate PO intake. She had presented to an outside hospital 5 times for further evaluation, and was diagnosed with endometritis, a UTI, and most recently infectious colitis for which she was on ciprofloxacin and flagyl with no improvement. On presentation to our hospital, she was tachycardic with abdominal distension and tenderness on exam. Labwork was notable for hemoglobin of 7.7 with MCV 80.3, ESR 79, and CRP 2.34. CT abdomen/pelvis was performed with concerning findings of mucosal hyperenhancement and bowel wall thickening throughout the colon. Infectious colitis work up was negative and the patient proceeded to undergo a colonoscopy, which revealed severe colitis with apthous ulcers within the ileum and throughout the colon, with sparing of the rectum. Biopsies confirmed a diagnosis of severe rectal sparing ileocolonic Crohn’s disease (CD). She was immediately started on steroids with the plan to transition to a biologic medication as an outpatient. DISCUSSION: Inflammatory bowel disease first manifesting in pregnancy is a unique presentation that is not well described or discussed in the literature. It has been estimated that approximately 4.1% of women diagnosed with CD are diagnosed while pregnant. This case is especially interesting as the patient’s symptoms were initially attributed to her recent pregnancy and delivery, despite her relatively classic IBD symptoms. Thus, CD and IBD should be considered in the differential diagnosis of abdominal pain in a pregnant patient, especially as early diagnosis and treatment may affect maternal and neonatal outcomes.