• Symptom onset – June 2020

• Diarhoea, intermittently streak blood+, mucous+

• Treated with antibiotics – syp. Taxim & metronidazole for ~3-4 months

• Elsewhere – Stool : E. histolytica cysts+ => treated with metrogyl

Oct 2020 (AIG)

On evaluation

• Presented with bloody diarrhoea & lethargy

• CBC – 7.8 / 26500 (N 77, L 13) / 5.3 lac

• Hs-CRP – 13.2

• Procalcitonin – 0.05

• Colonoscopy – Superficial ulceration & erythema with white exudates and loss of vascularity in entire colon --- Pancolitis

• Biopsy – Moderate active inflammation with crypt disarray -? Infective /? IBD

• Treated with antibiotics --- TLC subsided and pt started on Rowasa sachets & mesacol suppositories

• Symptomatically better

Current episode

• High grade fever spikes, Bloody diarrhoea (5-6/day), lethargy and increased sleepiness – since 12-15 days

• USG abdomen – Mild assymetric mural thickening in descending, sigmoid colon, paracolic subcentrimetric LN & mesenteric LN- ?inflammatory

• CECT abdomen – Long segment wall thickening with mucosal enhancement in Ac, TC, DC and sigmoid with prominent vessels & pericolic LN -- ?inflammatory / ?infecitve

• X-ray chest – Normal

• Widal – 1:20 titres (negative)

• Sr. procalcitonin –

• Blood cultures –

• Urine cultures –

• Stool cultures –

• Sigmoidoscopy – Multiple superficial ulcers with loss of vascularity in rectum & deep ulcers with whitish exudates in sigmoid

Issues

• Paediatric IBD – UC

• High TLC & high grade fever spikes

• Initially started on piptaz

• Changed to meropenem since 29/12/2020

• ?Infectious etiology / vs Inflammation due to IBD