A 24yrs old female presented with loose stools, small quantity, associated with mucus, around 6-8stools/day associated with tenesmus since march 2020 and bilateral lower limb swelling, facial puffiness followed by mild abdominal distention since 4months. Resorted to Ayurvedic meds 3weeks prior to admission following which she has developed striae over legs and lower abdomen. Weight loss of 12kgs over 6months. No H/o joint pains , redness of eyes, skin rash, abdominal pain, SOB.
Evaluation revealed bicytopenia, severe hypoalbuminemia(1.6), normal ESR, CRP and high fecal calprotectin.
CT enterography – Mild wall thickening with mural hyperenhancement in terminal ileum and distal ileal loops. Mural hyperenhancement noted in descending and sigmoid colon with prominent vasculature. Minimal ascites
Colonoscopy revealed deep serpigenous ulcers with cobblestoning in sigmoid, descending, transverse and ascending colon, apthous ulcers in ileum and few superficial ulcers in rectum.
Biopsy revealed chronic mild to moderate active colitis with granulomas.