A rare case of gastric Crohn's disease associated with immune thrombocytopenic purpura.

Crohn's disease (CD) is a chronic idiopathic inflammatory disease characterized by the segmental, transmural involvement of the gastrointestinal tract. Ileocolonic and colonic/ anorectal involvement is most common and account for 40% of the cases and involvement of small intestine in about 30%.1 Inflammatory Bowel Diseases (IBD), like CD, have been associated with various autoimmune conditions, with a cumulative prevalence of 8.2% to 10.5%.2 Concurrence of IBD with immune thrombocytopenia (ITP) is a rare phenomenon. Less than 20 cases have been reported in themedical literature and all of these patients had extensive colonic involvement. We are reporting a unique case, the first of its kind, of a patient with CD with isolated gastric involvement who was diagnosed with ITP. A 57 yr old male with a four year history of dyspepsia, nausea, vomiting and pain in the stomach after eating, and weight loss, presented to our hospital for evaluation of acute thrombocytopenia that was detected on pre-treatment labs at his gastroenetrologist's office. The patient had an upper and a lower endoscopy three months prior to admission. The esophagogastroduodenoscopy (EGD) (Fig. 1a) revealed multiple large friable, fungating, irregular, circumferential and pedunculated masses in the antrum of the stomach. The colonoscopy and capsule endoscopy exams were normal. Histopathologic examination of biopsies (Fig. 1b) from involved areas in the stomach was interpreted as chronic nonspecific granulating inflammation. Tests for helicobacter pylori were negative. The Prometheus IBD First Step Generation II test serological panel markers of anti-Saccharomyces cerevisiae antibody (ASCA) IgA assay was positive at 41.7, anti-Omp C (outer membrane porin from Escherichia coli) IgA 60.8, perinuclear anti-neutrophilic cytoplasmic antibody (p-ANCA) antibody was 16.9 while ASCA IgG and antibody to CBir1 (anti-CBir1 flagellin) was normal confirming the diagnosis of gastric CD. His physical exam on this admission was essentially unremarkable. He did not have a recent viral illness and he was not taking any medications. His stool was heme-positive. His labs revealed a mild anemia (hemoglobin of 9.3 g/dl) and thrombocytopenia (platelets 25 × 109/L) with giant platelets.