Ankle Manifestation from CD?

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Sep 13, 2010
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Hi,

Looking for help or anyone with a similar experience.

Dxed with Crohn's Disease in 1997 at age 22. I also have PSC (Primary Sclerosing cholangitis) dxed in 2001. I've been on prednisone since my dx and can never get down to lower than 10 mg every day without flaring.

I am currently treated for CD at Thomas Jefferson University Hospital in Philly which is a two hour drive from where I live but well worth it.

Over the past 13 years, 've had erythema nodosum, shingles, eye inflammation, blood transfusions, a collapsed lung due to an ERCP and too many hospital stays to remember.

Thankfully, the course of my disease has been very predictable. I usually have two bad flares per year, one in the fall and another the end of February beginning of March.

The symptoms I'm experiencing now however are completely new and since it's been a bit over 5 weeks that I've had them I'm becoming frustrated and somewhat anxious over what is causing them.

I woke up one morning and my left ankle was swollen to about the size of a baseball on both the inside and outside. It hurt to put pressure on it but I still had full range of motion.

Two nights later I had a fever of 101 so I decided to call my family DO the next morning.

An XRay, ultrasound and routine bloodwork have all come back normal. I've been to a podiatrist four times in the past three weeks and a nurse practitioner three times.

The pod fitted me for a walking boot and also withdrew some fluid from my joint and injected something similar to a steroid which for two days made the pain disappear but not the swelling. The fluid he withdrew came back normal.

I also had an MRI which showed significant swelling around my ankle joint and a ganglion cyst the size of a small marble which he said isn't causing the pain.

The inflammation has jumped around my foot and I've also had splotchy redness throughout which has seemed to settle in the back of my achilles tendon and on the inside of my ankle. The pain however has remained. I've been able to significantly reduce the swelling with elevation and ice.

The podiatrist is stumped, he has never seen this type of presentation before and thinks it is somehow related to my Crohn's Disease. I saw him this past Friday and at that point I was in agony, the entire foot was hot to touch and even he thought it looked worse than the Friday prior when he had done the injection. He bumped my prednisone to 60 mg 2 days, 50 mg 2 days, 40 mg 2 days, 30 mg 2 days and then back to my original dose. He told me to continue wearing the boot and to ice it as much as possible.

The family doc told me I had Cellulitis (even though I didn't have any of the symptoms) and prescribed 500 mg of Keflex twice a day for 7 days. I ended up taking the antibiotic on the advice of the podiatrist as a precaution.

I have an appt at the Rothman Clinic in Philly but it's not until the 22nd of this month.

I've spent countless hours searching for anything on the net regarding this but can't find anything that seems to fit.

If ANYONE has had a similar experience and knows what the heck is going on with my ankle, I would GREATLY appreciate your input.

Thanks for listening.
 
Hi Bosmom
and welcome

I'm not familiar with any of this but, do you think there's a possibility that this is Pred related? I ask because I remember my consultant telling me about swelling from long term Pred use, meaning years and years of it. He mentioned that there are a lot of people with swollen arms and legs and purple skin with long term use of steroids and that it is a side effect. He said he has seen it many times, especially with RA patients. I was thinking about your salt intake too? Too much salt can cause edema, especially on Pred. Another possibility is Lupus.
Hope someone else can help you, it must be a worry for you.
glad you found us and that you stick with us.
lotsa luv
Joan xxx
 
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I would get tested for the tick born disease of Bartonella. The symptoms are close enough to make it a possibility. Symptoms vary quite a lot. My wife only had one symptom, of swollen ankles.

If you have Bartonella, then you may also have Lyme Disease. Lyme disease also can cause other autoimmune diseases as is suppresses the immune system.

My wife has Lyme Disease, but her swollen ankles turned out to be Bartonella. She had the swollen ankles for five years, but they swelling went away when I used an unapproved Bartonella treatment. It has not come back since.

Lyme tests are not accurate, and I am not sure how accurate a Bartonella test is, but I think it is more accurate than the Lyme tests.

My best guess.

Dan
 
Thank you for the quick responses.

I'm not sure that it the swelling and redness would be related to long term pred use since the swelling has come down since I upped my dose but it is worth asking my GI about. Thank you.

I have also considered Lyme disease and have read that the test has a 50 percent accuracy rate.

I will read up on Bartonella and let you know if I think it might be a fit.

Will keep you posted.

Thanks
Erin
 
My left ankle has been swelling on and off for the better part of two years. It was one of the first things that started going whacky with me before my official diagnosis. The others were canker sores, intermittent low-grade fevers (mostly at night) and unbelieveable exhaustion. I now know that the sores, fever and tiredness are very common Crohn's symptoms, but was never able to figure out the swelling ankle!

The swelling started long before my steroid use. Both my legs swell at times, but mostly it's the left ankle and up the calf.

Please keep us posted on what you find out! I am curious to see if there are any others out there that have had the same problem!

- Amy
 
If anyone wants a quick and dirty Lyme test, this is the best one I know of.

Buy a bottle of Nutramedix Samento, or Cumanda. These are natural antibiotics from rain forest plants used in South America for treating infections. Cats Claw is much the same as Samento an you can get this at many health food stores.

Try the minimum dose of one drop in water. If you respond to this with flu like symptoms, you almost certainly have Lyme. Lyme is one of the few diseases that will cause this Herxheimer effect when some of the bacteria is killed.

Normal, no Lyme infected people do not respond in any way to this treatment, as I have tested it on myself. Especialy a very low one drop dose.

A doctor will not accept this as proof positive of Lyme Disease, but at least you will know what you may be dealing with.

Dan
 
Have you been to a Rheumatologist? As good as the people at the Rothman Clinic are, autoimmune diseases are really not their field of expertise. I have Crohn's arthritis that resembles RA (hot swollen red joints) but I don't test positive for it either. Having said that, it's always good to cover your bases with weird things like this (getting lyme tests, etc.) because it's very easy for them to shrug everything off as a symptom of Crohn's when it's actually something else.
 
Hi Bosmom, :bigwave:

Sorry, I can't offer up any advice but would like to welcome you aboard!

All the best, :)
Dusty
 
Hi Bosmom, I have sent you a private message as my son also has psc and crohns. I'm sorry, I can't speak to your ankle condition and I'm sorry for your situation, but I'm so glad you found your way to this forum!! Please stick around!!!
 
Slice,

Yes I have an appt with a Rheum. in October. The podiatrist that is following me has rheumi and I mentioned Peripheral Arthritis to him which he said it could be but since there isn't a test for IBD arthritis it's frustrating.

I agree about the Lyme's Disease test. I'm going to call my fam. DO and see if they will test me this week.

There are just too many manifestations of CD that it can be hard to differenciate what is related and what isn't.

thanks,
Erin
 
Hi.........I too have had a swollen ankle....the left one........my husband was convinced I must have gone over on it, but you know when you've twisted your ankle!!. Anyway mine wasnt half as bad as yours........only lasted 2 weeks tops but still a strange thing. Let us know what else you can find out about this, would be interesting to know

Ruth
 
Leaning towards Erythema Nodosum

Hey everyone,

Well since the pod upped my prednisone, the swelling is for the most part gone.

I have however developed two large, hard and painful bumps. One is on the outer part of my ankle above the bone and the other is on the back of my achilles tendon.

Several years ago I had EN on my right shin. Presentation was different but I'm thinking that maybe since it's the ankle it doesn't follow the same course since there is more movement. Just my thoughts.

Anyway, I have three doc appt's next week and am optimistic that one of them will have the answer and hopefully they will all agree. Nothing is worse than several diagnosese.

Thanks,
Erin
 
Hi Erin,
Welcome aboard! Glad to hear you are staying optimistic. I've been working on that myself, I am newly diagnosed, still not knowing what all will come of this. I wish I had some good advice for your problems with your ankle. I did want to mention though that I have a ganglion cyst in my left wrist. I've had it drained a few times, but it keeps coming back. (at one point it did give me pain..they can continue to grow and take up more space..) in the x-ray the cyst took up a good portion right in the center of my hand. The only way to get rid of it, per the doc, was to have it completely removed, however he didn't want to do that because they would have to cut me open frm my wrist up through my hand in a zig zag type incision which would possibly cause nerve damage, and it's not a good place to cut open b/c of the location inner wrist -> palm.

Well hun I hope the very best for you! And hope you stick around! This forum is absolutely great! It has made a big difference in my life over the past month!:emot-dance:
 
I have had alot lot of joint swelling with Crohns. I had my right ankle swell up so big. The Dr ended up draining it. It took a long time to heal. I was put on antibiotics intravenously. I was told it was just Crohns. When you have inflammaton, you have stuff deposit in your joints. I think it is white blood cells? Since going on Humira, I have not had any joint problems. (knock on wood)
 
Hi Erin. Make sure if they are thinking of doing a biopsy, the rule out Pyoderma Gangrenosum first. If it turns out to be this, a biopsy is going to put you in far worse shape then you are in now. My husband has had pg for over 2 years and the first Dermatologist he went to caused MAJOR damage.
Please keep us posted to your progress. I hope you get an answer soon.
 
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