Abdominal Aortitis Associated with Crohn Disease

Bronx Lebanon Hospital Center, Bronx, New York, USA Correspondence: Dr Hassan Tariq, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite 10C, Bronx, New York 10457, USA. Telephone 718-900-1234, e-mail htariq@bronxleb.org Received for publication July 31, 2013. Accepted September 19, 2013 Case Presentation A 26-year-old woman who was diagnosed with Crohn disease when she was 12 years of age presented with a two-week history of nausea, vomiting, worsening diarrhea and bilateral lower abdominal pain. The patient had a protracted history of Crohn disease treated with mesalamine, tapering short courses of corticosteroids for exacerbations and then 6-mercaptopurine therapy initiated three years before this presentation. Nine months before the patient presented, she was also started on subcutaneous adalimumab and maintained on a dose of 40 mg every other week. Her white blood cell count was 10×109/L (65.5% segmented neutrophils, 28.9% lymphocytes, 4.8% monocytes), with a hemoglobin level of 123 g/L and a platelet count of 164 ×109/L. An abdominal computed tomography scan revealed multifocal areas of mural thickening with narrowing in the colon (Figure 1), long-segment minimal thickening with narrowing of the upper abdominal aorta and maximal luminal narrowing in an infrarenal aortic segment (Figure 2). These findings were suggestive of aortitis, which is very rarely associated with Crohn disease.