A case of acute loss of vision as the presenting symptom of Crohn's disease.

BACKGROUND

An adolescent boy aged 17 years presented with sudden onset of visual impairment, which was rapidly diagnosed as bilateral anterior uveitis by an ophthalmologist. A systemic review noted episodes of nonbloody diarrhea, weight loss of 3 kg and a diminished appetite during the previous 10 months. The patient's family history revealed an older brother with Crohn's disease.

INVESTIGATIONS: Visual acuity test, slit-lamp examination, ophthalmologic fundoscopy and endoscopic evaluation of the upper and lower gastrointestinal tract with biopsy.

DIAGNOSIS: Multifocal Crohn's disease, involving the terminal ileum and cecum, in addition to the stomach and duodenum.

MANAGEMENT: Treatment with topical corticosteroids, in the form of ophthalmic drops and oral budesonide ileal-release capsules. Once remission was achieved, it was maintained with mercaptopurine.