Clinical Features

CD typically has a chronic intermittent course with episodic acute flares and periods of remission. Clinical features differ according to the severity of CD. Patients with mild CD may be asymptomatic while patients with fulminant CD have severe symptoms.

• Low-grade fever

• Weight loss

• Fatigue

CD most commonly affects the terminal ileum and colon, but involvement of any part of the GI tract (from mouth to anus) is possible. In contrast to ulcerative colitis, rectal involvement is uncommon.

• Chronic diarrhea

• Lower gastrointestinal bleeding (uncommon)

• Abdominal pain, typically in the RLQ

• Palpable abdominal mass in the RLQ

• Features of CD complications

  • Malabsorption (e.g., weight loss, anemia, failure to thrive)

  • Enterocutaneous or perianal fistulas, often associated with abscess formation [7]

Perianal fistulas and abscesses are often the first signs of CD.

Extraintestinal manifestations of CD are present in 20–30% of patients with CD. [9]

• Joints

  • Enteropathic arthritis

    • A seronegative spondyloarthropathy that develops in association with inflammatory bowel disease

    • Typically affects joints of the lower extremities but can also involve the spine (e.g., sacroiliitis, spondylitis, inflammation of peripheral joints).

  • Nail clubbing [10]

• Eyes

  • Uveitis

  • Iritis

  • Episcleritis

• Liver/bile ducts: cholelithiasis

• Urogenital system: urolithiasis (mostly calcium oxalate stones)

• Oral mucosa

  • Oral aphthae

  • Pyostomatitis vegetans

• Skin

  • Erythema nodosum

  • Acrodermatitis enteropathica

  • Pyoderma gangrenosum: a neutrophilic dermatosis

    • Associated with various conditions (e.g., IBD, rheumatoid arthritis, and trauma)

    • Manifests with very painful, rapidly-progressive, red spots that can change into purulent pustules or deep ulcerated lesions with central necrosis

    • Commonly located at extensor side of the lower limbs

    • Treated with immunosuppressants (e.g., corticosteroids, cyclosporine A)