A 9-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 26.0×109/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
Crohn's disease is a chronic transmural inflammatory process of unknown cause, involving any segment of the gastrointestinal
Bryk T, Weizman Z, Kurzbart E, Shulman H, Maor E, Tunnessen WW. Picture of the Month. Arch Pediatr Adolesc Med. 1995;149(2):197-198. doi:10.1001/archpedi.1995.02170140079013