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PEDIATRICS Vol. 104 No. 3 September 1999, p. e36

ELECTRONIC ARTICLE:
Yersinia Enterocolitis Mimicking Crohn's Disease in a Toddler

Received Jan 4, 1999; accepted Apr 19, 1999.

Anne Marie McMorrow Tuohy*, Molly O'GormanDagger , Carrie Byington§, Barbara Reidparallel , and W. Daniel JacksonDagger

From the Department of * Pediatrics, and Divisions of Dagger  Pediatric Gastroenterology and Nutrition, § Pediatric Infectious Disease, and parallel  Pediatric Radiology, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, Utah.

A 31/2-year-old girl presented with persistent abdominal pain, fever, vomiting, and diarrhea accompanied by rash, oral ulceration, anemia, and an elevated sedimentation rate. Initial evaluation revealed no pathogens and was extended to include abdominal ultrasound and computed tomography showing marked ileocecal edema and mesenteric adenopathy. Colonoscopy revealed focal ulceration from rectum to cecum with histology of severe active colitis with mild chronic changes. Enteroclysis demonstrated a nodular, edematous terminal ileum. Because of the patient's clinical deterioration despite antibiotics, these features were construed consistent with Crohn's disease, and glucocorticoid therapy was begun. By the ninth hospital day, admission cultures grew Yersinia enterocolitica, and trimethoprim/sulfamethoxazole was begun followed by prompt clinical improvement. The delay in diagnosis afforded an unusually comprehensive clinical description of the presentation and diagnosis of Yersinia enterocolitis in childhood.

 Key words:  Yersinia enterocolitica, Crohn's disease, child, radiology, colonoscopy.