Title: Multiple sclerotic osseous lesions in a young patient with Crohn’s disease

Title: Multiple sclerotic osseous lesions in a young patient with Crohn’s disease.

Submitted by: Mounir B Errami MD PhD MBA+ and Orhan Oz MD PhD*

+ Parkland Hospital, 5200 Harry Hines Blvd, Dallas, TX 75235.

*Corresponding author email: orhan.oz@utsouthwestern.edu, University of Texas Medical Center at Dallas, 5323 Harry Hines Blvd. , Dallas, Texas 75390

Patient History:

A 20-year-old male with ileocolonic Crohn’s disease diagnosed in 2014, with a reported history of steroid use for at least two months, and presently on Remicade and in remission. His course had been complicated by perianal fistulas for which he underwent fistulotomy in 2015. The patient has had several hospital admissions for Clostridium Difficile colitis (two admissions in 2018, treated with and responded to vancomycin). As part of his routine care, the patient underwent osteoporosis screening by DXA (Figure 1) following the guidelines of the American College of Gastroenterology and the American Gastroenterology Association.

The patient had also complained of right knee pain. Radiographs of the knee were also obtained (Figure 2). In addition, given recurrent episodes of abdominal pain, a CT scan of the abdomen and pelvis was obtained and as axial section through the femurs was available for review (Figure 3).

Case of the Month image 1

Region BMD (g/cm2) T-Score Z-Score
AP Spine 1.119 -0.9
Femur Neck Left 1.073 -0.3
Femur Total Left 0.897 -1.5
Femur Neck Right 1.115 0.1
Femur Total Right 0.939 -1.2
Left Forearm Radius 0.738 -2.5
Figure 1. DXA scan images and BMD results for bilateral hips, and spine. Due to unusual appearance of the hip images, a forearm scan was also performed, and results are also shown.
Case of the Month image 2
Figure 2. AP and lateral views of the right knee.
  1. Elaborate a differential diagnosis. Are any of the conditions in your differential associated to Crohn’s disease?
  2. Given the distribution of the lesions and their appearance, does this help refine your differential diagnosis, including any conditions not necessarily associated with Crohn’s disease?
  3. This patient has Crohn’s disease. Why, in your opinion, is osteoporosis suspect to the extent that it warrants evaluation by DXA?
  4. Does this patient have osteoporosis?

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