Challenges in Diagnosis and Management of Crohn's Disease in Bangladesh With Long Term Follow-Up.

Crohn's disease (CD) is a chronic autoimmune inflammatory bowel disease (IBD) with significant diagnostic and therapeutic challenges. We reported a case of a 20-year-old Bangladeshi male with an 8-month history of severe upper abdominal pain, bowel discomfort, and intermittent low-grade fever. Initial investigations showed mild anemia and elevated inflammatory markers. Magnetic resonance enterography revealed distal small bowel thickening, suggestive of IBD. Colonoscopy and biopsy confirmed chronic ileitis without granulomas and an ulcer at the terminal ileum. Despite the absence of granulomas, clinical symptoms, elevated fecal calprotectin, and high C-reactive protein (CRP) led to a diagnosis of CD. The disease later progressed to a perianal abscess, a fistulizing complication. The patient received three doses of infliximab but subsequently discontinued therapy. He remained untreated for 3-years and subsequently developed an intestinal perforation requiring right hemicolectomy with ileostomy. Following ileostomy reversal, adalimumab was advised. This case highlighted the diagnostic and therapeutic challenges of CD in Bangladesh.