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Clinical Picture
Tulio Bryk, MD;
Zvi Weizman, MD;
Edna Kurzbart, MD;
Hanna Shulman, MD;
Esther Maor, MD;
Walter W. Tunnessen, Jr, MD
Arch Fam Med. 1995;4(10):826-827.
Abstract
A9-MONTH-OLD boy was referred for evaluation of severe perianal disease and suspected sexual abuse. The relevant medical history was unremarkable except for chronic, recurring diarrhea. On physical examination, the infant was pale, ill-looking, and malnourished. Severe perianal inflammation was present along with anal fissures and skin tags (Figure 1). Diarrheal stool with mucus and streaks of blood was passed. Significant laboratory data included a hemoglobin level of 9.5 g/dL, white blood cell count of 26.0X109/L, erythrocyte sedimentation rate of 85 mm/h, and a stool smear showing a large number of leukocytes. Stool specimens for culture and parasite examination were negative. A barium enema (Figure 2) and, eventually, a colectomy (Figure 3) were performed. A microscopic section of the colon is shown in Figure 4.
Denouement and Discussion
Infantile Crohn's Disease
Figure 1. The perianal area is inflamed with tears and fissures.
Author Affiliations
From the Departments of Pediatrics (Drs Bryk and Weizman), Pediatric Surgery (Dr Kurzbart), Radiology (Dr Shulman), and Pathology (Dr Maor), Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel, and the American Board of Pediatrics, Chapel Hill, NC (Dr Tunnessen).
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