Bacterial dysentery complicated with Crohn’s disease: A case report

Rationale: Crohn’s disease is easily confused with bacillary dysentery in clinical manifestations. Crohn’s disease is a chronic disease that can involve both intestinal and extraintestinal areas, and severe patients have prolonged and poor prognosis, so early diagnosis and treatment are crucial for patients. This case is a combination of bacillary dysentery and Crohn’s disease, which emphasizes the differentiation between bacillary dysentery and Crohn’s disease, and expects clinicians to pay attention to and discover the early manifestations of Crohn’s disease. Patient concerns: A young male was admitted to the hospital with recurrent abdominal pain. Based on the patient’s symptoms, imaging, enteroscopy, and pathology, we concluded that he had “acute bacillary dysentery and Crohn’s disease combined with bladder fistula.” Diagnoses: 1. Acute bacillary dysentery, 2. Crohn’s disease combined with bladder fistula, 3. urinary tract infection. Interventions: The patient was treated with 390 mg intravenous infusion of ustekinumab, anti-infection, antispasmodic, regulation of intestinal flora, repair of intestinal mucosa, fluid rehydration, nutritional support, etc. Outcomes: The patient’s abdominal pain was improved, no more blood in the stool, urinary frequency and pain were improved, and urine color was clear. Lessons: In the course of diagnosis and treatment, the patient’s bacillary dysentery was clearly diagnosed, so the corresponding treatment was given, and there was a good effect in the treatment process, so the possibility of complications was not paid attention to. At the same time, Crohn’s disease (CD) is a chronic nonspecific inflammation of the intestine, which is difficult to diagnose. Moreover, some manifestations of CD under endoscopy are similar to those of bacillary dysentery, which increases the difficulty of diagnosis. In this case, the initial treatment of bacillary dysentery was good, but CD was found in the later stage when the disease was repeated and complications occurred, delaying the diagnosis and treatment of CD. Therefore, this paper reviewed part of the literature, summarized and identified the epidemiology, clinical manifestations, endoscopic manifestations, and pathological manifestations of bacillary dysentery and CD, hoping that clinicians can pay attention to and discover the early manifestations of CD.