Palpebral ptosis with episcleritis and Crohn’s disease

Key words: Crohn’s disease, Extraintestinal manifestations, Palpebral ptosis, Episcleritis

The paper describes the case of a 12-year-old boy who presented with asthenia, weight loss, and right palpebral ptosis associated with episcleritis during the last three months. Blood tests showed an increase in the sedimentation rate and faecal calprotectin, while P-ANCA and ASCA were negative. Abdominal ultrasonography revealed ileal parietal thickening and parietal hyperaemia with mesenteric lymphnodes of increased size. Oesophagusgastroduodenoscopy and colonscopy showed normal macroscopic findings. The ileocecal valve did not present inflammation signs but could not be passed through. Only at the colon level did the histological test show mucosal increased plasma cells, lymphocytes, neutrophyls and eosinophyls with cryptitis, without granulomas. Capsule endoscopy detected multiple ulcers covered with fibrin scattered all over the ileal loops. Crohn’s disease with extraintestinal manifestations was diagnosed. 8-week exclusive oral polymeric diet treatment led to clinical remission, including ocular manifestations and sedimentation rate, PCR and faecal calprotectin normalization.