P1262 - Concurrent Presentation of Crohn’s Disease & Sickle Cell Crisis in an 18-Year-Old Male: A Case Report

Ujjwal P. Dutta, MBBS¹, Jugal Hiren. Bhatt, MBBS², Nency Kagathara, MBBS³, Bhoomi Bavadiya, MBBS¹, Maurya Joshi, MBBS¹, Kahan Mehta, MBBS¹, Tithi Manjibhai. Savani, MBBS⁴, Linda Bett, ⁵, Maureen Bett, ⁵
1GMERS Medical College and Hospital Gotri, Chicago, IL; 2GMERS Medical College and Hospital Gotri, Voorhees, NJ; 3Zydus Medical College and Hospital Dahod, Vadodara, Gujarat, India; 4GMERS Medical College and Hospital Sola, Chicago, IL; 5International University of Health Sciences, Chicago, IL

Introduction: The co-occurrence of Crohn's disease (CD) & sickle cell disease (SCD) presents diagnostic challenges, as 30% of SCD patients experience GI symptoms mimicking CD flares. With 100,000 SCD patients in the U.S., this overlap complicates management, often delaying diagnosis (40% of cases) & leading to inappropriate steroid use (62%). We present an 18-year-old male with quiescent CD (Paris A1bL1L2B1) whose SCD crisis mimicked a CD flare, highlighting the critical role of clinical evaluation to differentiate these conditions & guide therapy in this high-risk population.

Case Description/

Methods: An 18-year-old male with known Crohn's disease (Paris A1bL1L2B1 phenotype) presented with acute abdominal pain, vomiting, & profound hypotension (78/54 mmHg). Initial labs revealed critical pancytopenia (Hb 5.3 g/dL, WBC 2450, platelets 83,000), AKI (Cr 4 mg/dL), & metabolic acidosis (pH 7.30). Positive sickling test confirmed previously undiagnosed SCD. After packed RBC transfusion (Hb improved to 7.3→10.5 g/dL) & IV hydration (Cr normalized to 0.8 mg/dL), colonoscopy showed quiescent Crohn's (SES-CD 2, Modified Mayo 1) without active inflammation. Multidisciplinary care (GI/hematology/nephrology) avoided immunosuppression per ACG-modified protocols, achieving clinical stabilization within 7 days.

Discussion: This case throws some light on the diagnostic complexity of Crohn's-SCD overlap, where vaso-occlusive crises (Hb 5.3→10.5 g/dL, hypotension 78/54 mmHg, AKI Cr 4→0.8 mg/dL) perfectly mimicked IBD flare. Endoscopic evaluation (SES-CD 2, Modified Mayo 1) proved critical to confirm quiescent Crohn's and avoid harmful immunosuppression per modified ACG criteria (Hb < 7 g/dL threshold). Three key insights were noted including 1. IBD-like symptoms in SCD patients demand endoscopic verification before biologics/steroids, 2. Multidisciplinary co-management (GI/hematology/nutrition) is essential to balance competing risks (e.g., anti-TNFs during crises may worsen outcomes), and 3. Unexplained anemia (Hb < 7 g/dL) in young IBD patients should prompt SCD screening. These findings directly inform ACG guideline gaps, proposing protocolized endoscopic assessment for this high-risk population. The case establishes a new management realm where endoscopic activity confirmation precedes immunosuppression in patients with a dual diagnosis, preventing iatrogenic harm while optimizing IBD control.

Disclosures:
Ujjwal Dutta indicated no relevant financial relationships.
Jugal Bhatt indicated no relevant financial relationships.
Nency Kagathara indicated no relevant financial relationships.
Bhoomi Bavadiya indicated no relevant financial relationships.
Maurya Joshi indicated no relevant financial relationships.
Kahan Mehta indicated no relevant financial relationships.
Tithi Savani indicated no relevant financial relationships.
Linda Bett indicated no relevant financial relationships.
Maureen Bett indicated no relevant financial relationships.

Ujjwal P. Dutta, MBBS¹, Jugal Hiren. Bhatt, MBBS², Nency Kagathara, MBBS³, Bhoomi Bavadiya, MBBS¹, Maurya Joshi, MBBS¹, Kahan Mehta, MBBS¹, Tithi Manjibhai. Savani, MBBS⁴, Linda Bett, ⁵, Maureen Bett, ⁵. P1262 - Concurrent Presentation of Crohn’s Disease & Sickle Cell Crisis in an 18-Year-Old Male: A Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.