Challenging differential diagnosis, Rare disease
Bong Soo Park, Sihyung Park, Kyubok Jin, Yeon Mee Kim, Kang Min Park, Jeong-Nyeo Lee, Toyomi Kamesaki, Yang Wook Kim
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
Am J Case Rep 2014; 15:550-553
Anemia is a common, important extraintestinal complication of Crohn’s disease. The main types of anemia in patients with Crohn’s disease are iron deficiency anemia and anemia of chronic disease. Although patients with Crohn’s disease may experience various type of anemia, autoimmune hemolytic anemia (AIHA) in patients with Crohn’s disease, especially Coombs-negative AIHA, is very rare.
Case Report: A 41-year-old woman with Crohn’s disease presented to our emergency room (ER) with dark urine, dizziness, and shortness of breath. The activity of Crohn’s disease had been controlled, with Crohn’s disease activity index (CDAI) score below 100 point. On physical examination, the patient had pale conjunctivae and mildly icteric sclerae. Serum bilirubin was raised at 3.1 mg/dL, lactate dehydrogenase (LDH) level was 1418 U/L and the haptoglobin level was <3 mg/dL. Results of direct and the indirect Coombs tests were all negative. We then measured the RBC-IgG to evaluate the possibility of Coombs-negative AIHA. The result revealed that RBC-IgG level was 352 IgG molecules/cell, with the cut-off value at 78.5 IgG molecules/cell.
Conclusions: We report a case of Coombs-negative AIHA in a patient with Crohn’s disease with chronic anemia, diagnosed by red blood cell-bound immunoglobulin G (RBC-IgG) and treated with steroids therapy.
Keywords: Anemia, Hemolytic, Autoimmune - diagnosis, Adult, Colonoscopy, Coombs Test - methods, Crohn Disease - diagnosis, Diagnosis, Differential, Tomography, X-Ray Computed