Severe malnutrition and persistent myopenia despite weight recovery in newly diagnosed stricturing Crohn's disease: A case report.

Protein-energy malnutrition is a common complication in Crohn's disease (CD). In addition to weight loss, patients may develop significant alterations in body composition, including skeletal muscle depletion, which can negatively affect clinical outcomes and quality of life. Herein, we report on a patient with newly diagnosed CD who presented with severe malnutrition and myopenia, which persisted despite improvements in nutritional intake and body weight. A 27-year-old woman was admitted with abdominal pain, decreased appetite, nausea, vomiting, and progressive weight loss (10 kg, 22% of her usual body weight). Based on clinical presentation, family history, and magnetic resonance enterography findings, stricturing CD was diagnosed. Nutritional assessment revealed severe malnutrition (body weight, 31 kg; body mass index, 12.26 kg/m2; phase angle, 4.4°, intracellular-to-extracellular mass ratio, 0.75). Computed tomography-based body composition analysis demonstrated marked skeletal muscle depletion (skeletal muscle index, 27.5 cm2/m2), confirming myopenia. The patient was treated with corticosteroids, infliximab, azathioprine, and multidisciplinary nutritional management. After 12 months of follow-up, she achieved clinical remission and gained approximately 25% of her initial body weight. Despite significant weight recovery and improved dietary intake, computed tomography (CT) revealed low skeletal muscle mass and increased visceral and subcutaneous adipose tissue, indicating persistent myopenia. This case highlights the importance of comprehensive body composition assessments in CD. Clinical remission and weight gain may not accurately reflect recovery of skeletal muscle mass. Early nutritional evaluation and longitudinal body composition monitoring may be helpful in the management of patients with CD to identify persistent muscle depletion and optimize long-term outcomes.