Any Misdiagnosed Teens?

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Hi All!
Have had a very scary two weeks in the hospital with my 16 yo daughter. I initially thought she had picked up a bug and had terrible stomach pain, nausea and diarrhea in the middle of the night. Suddenly she began bleeding and I took her straight to the ER. They did a CT scan and noticed lots of inflammation discussed IBD as my mother has UC or possibility of infection (tho she had no fever) took stool samples and admitted us because of pain and now heavy bleeding. Once she was rehydrated they did a colonoscopy and the doctor came out and told me she totally had severe Crohn's. She went thru needing to drink bright beginnings soy drink for 8 weeks then biologics every week then every other and eventually every 8 weeks for the rest of her life. She kept asking if she had any weight loss or pain or diarrhea or any symptoms prior to our night before the given the severity of the inflammation to which I replied over and over NO. What she did have was a recently diagnosed milk allergy and frequent nausea/vomiting when eating pizza or lasagna or things high in milk/cheese. I know you know what that night was like, hearing the diagnosis, researching and soaking up all info possible, not sleeping...the wondering what did I do or didnt I do to cause or prevent, what hasn't she been telling me...how am I going to tell her, help her, choose the right path for her, on and on until the next day when the biopsies came back....none of which indicated any Crohn's!?! Thrilled...yet confused and fearful. They thought maybe ischemic colitis based on biopsies then ruled that out, no UC, back to infection but six cultures each done three days apart have all been neg for c-dif,campylobacter, shigella all of them. I am fearful they are A. missing something and B. it really is Crohn's but we just don't know it yet. My question is how many of you were misdiagnosed initially or have had a similar experience seeking a diagnosis? We were discharged last week after 13 days in the hospital...she was really sick. Has anyone had experience with eosinofil colitis? Thanks for your help and support .... I'm so frazzled and afraid for her. I know Crohn's is treatable but it is terrible and scary and overwhelming 14 days in or out. Thanks again for any insight you can offer.
 
Sorry you have been through so much I'm going to tag my little penguin and farmwife they both have children although much younger that deal with a lot of food allergies and EoE diagnosis. Hopefully they will be along soon and see the tag.
 
Sounds like you and your daughter have been through a lot! And it can be nerve wracking to being told one diagnosis and then another. I can't speak to misdiagnosis personally but it does happen unfortunately. There are folks on the forum who have had different diagnoses before they finally were diagnosed with Crohn's and it's also possible for a doctor to think Crohn's and it end up being something else.

So am I right in understanding that the doctor thought she had Crohn's based on the colonoscopy and then said it wasn't based on the biopsies? What did the doctor say was the likely cause then? Do you have the biopsy report, and if so, what did it say? How is your daughter feeling? Is she on any medicines now?

HUGS to you and your daughter.
 
Thanks for your reply, xmdmom! Yes, you're right, based on colonoscopy Tues am they Dx Crohn's. it is even typed on Dx of colonoscopy report in black and white. Late next day Wed pm the biopsies came back with no evidence of Crohn's. Dr was so sure she went through treatment plans and everything short of naming biologics. Biopsy report said lots of things mostly indicating areas of ischemic colitis. That is very scary too dealing with heart, blood flow and clotting disorders - none of which we have. They ended up starting us on flagyl and asacol iv while in the hospital then after a course of iv flagyl did 5 days of cipro before beginning ENTOCORT (9mg 1x a day) which we are on now along with asacol(mesalamine 800 mg 2 x a day) and Prevacid, vitamin D and other multivitamins and probiotics
 
Oh, and Zofran for nausea that seems to be less and less each day. Overall she's much improved but I can't shake the feeling this isn't the end of it....Partly because of the misdiagnosis and partly because she's had unexplained nausea/vomiting off and on throughout her childhood which we attributed to milk sensitivity (now allergy) and wonder if they aren't somehow connected. Thank you for your support....just "getting it out" with another mom who has been there is so valuable. I appreciate you taking the time to share your knowledge with me.
 
If you can post the actual wording of the biopsy report, it would help clarify the situation. Sometimes the pathologist doesn't call it Crohn's because they don't see granulomas. However most biopsies of Crohn's don't show granulomas but finding a granuloma can help make the diagnosis. I'm guessing that ischemic colitis would be exceedingly rare in a teen. (My son, now 21, is on entocort 9 mg.)

How did the doctor leave it? Did s/he say it's colitis but we don't know what kind or does s/he think it's milk allergy?
 
At the end of everything struggling to figure it out they left it as severe infectious colitis in absence of any positive stool samples (tested repeatedly). They said her milk allergy has nothing to do with the severe inflammation. They also said the inflammation could be from either chronic or acute cause (IBD or infection) and sometimes it can be hard to distinguish when everything is inflamed so they did an MRI before sending us home to make sure inflammation was getting better and want to do a repeat colonoscopy next month. The report reads congestion, edema, erosions, friability, granularity, loss of vascularity, mucus and pseudo polyps. I feel sick reading it.
 
My daughter's symptoms did not come on suddenly, but we are in a bit of diagnosis limbo as well. So many more rare disorders can present like Crohn's making an accurate diagnosis very tricky. I would likely speak with the GI and try to determine what other testing could be done to figure out exactly what you are treating. In our experience, throwing medicine at an unknown disease only complicated things, and in the end we've had no other choice but to take a "wait and see" approach.
 
God bless you and your sweet babies and extended families dealing with this diagnosis FOR SURE day in and day out...
 
Gosh, DanceMom, I'm sorry to hear you're in a similar boat. I actually asked for a pediatric rheumatology consult incase the intestine was a part or symptom of a bigger systemic issue. The GI disagreed but did it anyway. Have you gone that route yet? We did blood test -ANA that can shed some light on things and at least help you see if further rheum testing is warranted. If I'm not mistaken you can keep your eye on the sed rate and crp number when doing blood work too in relation to each other to help determine chronic vs acute illness - not necessarily autoimmune specific that way though. I'm so NOT a dr or nurse but picked up a few things the last few weeks!
 
So it's wait and see... which is much easier for the doctor than for you and your daughter.
Glad she's feeling better and hope it stays that way!

Is your doctor an experienced GI doc who sees a lot of IBD?
 
This website covers food allergies and eosinphillic colitis:
http://community.kidswithfoodallergies.org/forum/eosinophilic_disorders

It's for parents of kids with food allergies including EC..

How was she diagnosised with food allergies ??
Did she have a rast or a skin test for IgE allergens ?
Has she seen a pediatric allergist ?
What type of reactions did you see ?
Most happen within 30 minutes of ingestion but can happen up to two hours later.

True food allergies require an epipen to be prescribed.


EC is different in that there would be a high number of eosinophils in the biopsies taken from the large instestines/rectum.
Cchmc ( Cincy children's ) has the center for eosinophilic disorders it is one of the top places in the country .
The other place would be national Jewish hospital in Denver Colorado .

Apfed has information on egids as well.

http://www.apfed.org/drupal/drupal/index.php


Eosinphils increase as you go down the Gi tract so that is normal to find some but not a lot.


Another thing to consuer is mast cell disorder .
Similar to EC but has more allergic side of things .


Did they do any imaging studies ( Mre or pill cam)?
These can tell if disease is hiding in the small bowel since scopes can not see that at all .

Also a stool test known as a fecal caloprotectin test may be helpful -
It determines if there is inflammation .


They thought DS had EC prior to his colonscopy at age 7.
After the scope the Gi said it looked normal so it was food issues.
Biopsies confirmed crohn's with multiple granulomas .

We had two second opinons for DS.
You can get the biopsy slides sent to cchmc and all her records .
They will then review everything including your slides.
They will not give you an appt at the center for eosinophilic disorders unless they feel there is a strong possibility of your child having an egid .

You can see any of their gi's as a normal patient though.
The other top Gi centers in the US at least are chop and Bch



Good luck
 
Yes, our GI referred us to a Rheumo and they work closely to make decisions regarding my daughter's care. At this point we are looking at the possibility of Crohn's, an immune deficiency, polyarteritis nodosa, or a combination of those things. Testing can be time consuming, expensive, and emotionally draining. I bet the Rheumo will be very helpful in your daughter's case and will probably mention some possibilities other than IBD. You were very smart for requesting the consult. Silly me thought that Rheumos only treated arthritis, lol. You live and you learn.....
 
Very good question! We specifically went to the children's hospital affiliated with a well respected children's clinic but I did not like the GI doc we saw in ER. Turns out he was a resident and not the doc we saw once we were admitted. I liked the new one very much, felt comfortable and confident but after crying my eyes out over "its not the flu its Crohn's...oh wait it potentially isn't Crohn's" the department head took over my daughter's case. He didn't take it from her, I think their hospital rotations overlapped and we transitioned from one to another...but I feel 100 % more comfortable with him now...and given the choice my daughter choses to see him too.
 
THANK YOU My Little Penguin for your fact filled reply! I actually called our allergist this afternoon and several of his comments overlap yours. Thank you! We did a skin test for her allergies and she was only mildly allergic to milk (along with pets and grasses and pollens) and like me has an allergy to cold (cold urticaria). The allergist feels she's outgrowing the milk allergy and it is not major at all, certainly not requiring an epipen. I've got one and an auvi-q for food and drug (and cold) allergies and my 10 yo niece has several life threatening food allergies so while my daughter doesn't have any others (yet) they certainly run in the family...as does ulcerative colitis. The pill camera is a great idea! The allergist mentioned how difficult it is to see or biopsy small bowel. The GI dr said the eosinophils were counted in an upper endo biopsy and in colon and numbers were within normal limits but I haven't seen that part of the report for myself. The allergist was going to call the GI dr as a courtesy to be sure...as we were still looking for a diagnosis. He did ask if she had a rash or hay fever or if anything else triggered or new food was eaten that day and nothing came to mind. Her hives with the cold exposure are instant and very obvious. So many pieces to put this puzzle together. I will
certainly read up and check out the links youve given. Thank you for helping us try and solve this mystery!
 
My then 7 year old daughter ended up in Hospital for two weeks with an Abscess on her small bowel and her GI was betting his house on it being Crohn's. Colonoscopy showed nothing and we went on our confused merry way. Two years later we were seeing him again for stomach pain in the same area, and after another Colonoscopy he tells us mild to moderate inflammation on biopsies meant that yes she did have crohns. He phones the following day to tell me he has changed his mind again and inflammation is due to the prep. She still suffers daily with tum pain and weight loss. So yes she was diagnosed two times then undiagnosed. We are stuck with ibs diagnosis at present.:ybatty:
 
Hi and welcome.
My girl has EGID's along with IBD....well that dx seems to changing.

I was told by the GI that TRUE eosinophilc colitis has a number over a hundred. My Grace was 70 at last scope.
IBD itself can have raised eosinophil's as part of the inflammation process. They believe Grace has eosinophil driven IBD. I've never heard of this so I've been researching it carefully. So far what I've found in the way of research papers is it has to do this refectory Crohn's. I hope this isn't the case but does seem to be shaping up that way for Grace. Still more research has to be done on this area.

Keep in mind that a dx can change anytime and maybe the dx of eos colitis is a way the doctor is making sure that your girl is still getting help, as where no dx is harder for insurance to cover any medicine.

I do feel that Grace's diseased area is in the upper GI track. We still haven't done a pill camera. I will be pushing at next scope for the camera.

Hugs
 
Just wanted to say I'm sorry you are in this situation. :( We were back and forth, testing with our ped for a couple of months before diagnosis as well. However, once we went to our children's hospital, they were able to tentatively diagnose my son within hours, based on labwork, symptoms and ultrasound; a colonoscopy, a few days later, confirmed the diagnosis. As I'm sure you've realized, you are not alone in finding that a firm diagnosis can, sometimes, take time.

Do try to start keeping a journal - symptoms, foods, activities, etc. - anything that might help isolate symptoms and their triggers.

I hope you are able to get firm answers soon! :ghug:
 
My daughter was diagnoses with Crohns and now they have changed it to U.C.
I honestly believe cutting out the foods she is allergic to will help. She must do it completely however, and dairy comes in different forms.

My older daughter fits the normal food allergy symptoms and reacts instantly to dairy and wheat. But she also has long term responses.

Our daughter with U.C. cant be tested for food allergies until she is off of the meds. I am so hopeful that once we find out what she is allergic to and eliminate it completely, she will go into remission.

Has your daughter ever eliminated dairy completely?
wishing you both the very best
 
Thanks for the warm welcomes and helpful advice. Dairy is officially history and the journal is a GREAT idea...thank you all!
 
I can't offer advice better than what I read above. It sounds like your daughter received care from a teaching hospital, which is good. Yet you don't know have answers you need. Would a second opinion from CHoP, Boston Children's or another large center be possible?

The uncertainty has to be scary. I hope you get answers soon, and I hope those answers come with solutions. Keep us posted. You sound like a great advocate for you daughter. You'll get the answers!
 
My mother received care from an IBD specialist at Cleveland Clinic in the past. I recall his explanation about stool studies-- that unless a patient supplies a fresh stools specimen at the lab and it is tested immediately, many stool pathogens can be missed. That wasn't very encouraging, and it wasn't anything previous GI doctors explained to my mother.
 
That makes sense and they didn't really explain it as well as you - thank you. while we /she was in the hospital as an inpatient the nurses came right away and zipped it on down to the lab..for at least two of the days the tests were ordered. They did offer two other possibilities the first that we had her there right away as things were really just taking hold (which another doc and my nurse practitioner sis don't really buy) and therefore too early to detect and the difficulty in actually getting these things to grow in a lab. Doc said out of the 6 or 7 they know about and can test for there are thousands they do not and cannot.
 
It is certainly a convincing theory that bacteria play a big roll in IBD. I did not know about the fresh specimen. However, there has to be another way to keep the specimen ready for testing (refrigerate immediately, freeze?)

I think getting tested for as many pathogens as possible is such a great idea. However, I cant help but wonder if some medications could give a false negative as well.
It is still worth pursuing!!
 
(Just to clarify my above comment-- the doctor my mother saw was not stating the pathogens caused IBD. He was seeking other causes for my mother's symptoms. She did not leave CC with a diagnosis of IBD. But his comment about stool specimens stuck with me. Something I did not know.)
 
I would ask your gi doc about the pseudo polyps. From what I read on the internet, they are seen with repeated cycles of ulceration -- so with something chronic. This would go against the theory of an acute infection. BUT I AM NO EXPERT. They can be seen in different kinds of colitis but might have other causes.

"The repeated cycle of ulceration, alternating with the deposition of granulation tissue during the healing phase, results in the development of raised areas of inflamed tissue that resemble polyps."

Do you have the microscopic part of the path report where they write about the inflammatory cells they see etc?
 
More good advice. Thank you. I need to look through the huge folder of results and bloodwork and med info sheets and see what I can find. Though we haven't had years of tests etc she's always been prone to nausea and vomiting...again attributed to dairy sensitivity now milk allergy which we would avoid but since the colonoscopy and such severe inflammation and Crohn's "confusion" I'm just not sold on acute infection. I'll look into this. Thank you!
 
Hi Mugz- Celiac's can also cause inflammation. Please let me know if they looked for that. Celiac's has a distinct image in biopsies, so they should have been able to look for that when they took the samples. Please double check on this if you haven't already. As you said she responded poorly after pizza and lasagna; Pizza/lasagna are also high in gluten.... this is what triggers Celiac's.
 
Thanks so much for your help! I had the same thought and asked the GI - they did biopsy for it but I called my allergist anyway who echoed just what you said about gluten but explained a little more about small bowel involvement and the fact she had no weight loss or diarrhea at all prior to this episode. Being home with her and away from work at the moment I've spent today researching this like it's my job and found a little tidbit that I think helps me connect the unfortunate unspoken dots my docs have alluded to but didn't come right out and say. Its a medscape article that stated patients that present with an unexplained acute attack that cannot be attributed to another cause (unspecified maybe...I'm not doing it justice) need to be watched as 50% will go on to develop Crohn's in 2 1/2 - 3 yrs. I know not to believe everything you read and literally googled "what mimics Crohn's disease" . Felt better as much of it really was infection some even minus pos culture but even with many infections the inflammation became chronic... I'm sorry...I just don't want any part of this stuff!!!! No one does...I know....but really....why does it have to happen to your child???
 
Check out the pediatric research section at the top of the parent page
Tons of papers with links on there to peruse through .

Doc like to think in generalities some are good with only kids who fit in the box in terms. Of bloodwork symptoms or tests .
Some will work with you to find an answer despite not fitting in the box .
DS does not ever fit in the box .
He has no bloody diarhea normal bloods etc...
But at the end of the day still has crohn's .

Mastocystic entercolitis sometimes is referred as early crohn's .

Before dx is harder since you have a hard time coming up with a plan of attack .
 
HI Mugzilla,
Im so sorry to hear that you have been going through a difficult time. My 18 y.o son had years of undiagnosed vomiting, and than last year he had one terrible episode. The Dr's originally did a colonoscopy and said he didn't have crohns based on his results and blood work. I insisted they do a gastroscopy ( because I have family history of colitis) and they found crohns in his duodenum ( rare). I hope you figure out what caused her symptoms!
Good luck and I wish your daughter the best of health.
 
^^^ yeah that
Did they do an upper scope as well?
DS also had vomiting issues associated with crohn's in the duodendum ( plus other places as well)
 
They did upper and lower scope and as pain and vomiting continued when she would drink water two days then 4 days later (we were still inpatient) they repeated X-rays and did MRI Looking for small bowel obstruction or anything else they'd be able to see. Didn't find one thank goodness. They did CT scan with contrast they injected and she drank when we first went to ER on FRI 5/2. didn't see one then but thought it could have happened from that time to next X-ray done on 5/9. Did another X-ray 5/12 and MRI on 5/14. Her colonoscopy was right in the middle on 5/6. I'm afraid to ask what the "oscopy" was you mentioned to look into duodenum and how involved the procedure is. We've been told she needs another scope this summer to take another look after inflammation is better and "infection" resolved though she's now on asacol and budesonide for 6 weeks so I'd imagine that could impact findings too? Will look under heading you advised! Thanks again....you're all awesome! What a wonderfully responsive, supportive and sincerely helpful group of warriors are here!!!
 
So here is what I was referring to. It states IBD, not specifically Crohn's or UC. It was from an article titled "Crohn's Disease and Infections. A Complex Relationship" from ncbi.nlm.nih.gov MedGenMed 2004
Diarrhea and Colitis in Immunocompetent Patients
Acute Diarrhea (< 1 Week) Acute watery diarrhea is often of viral etiology. Stool cultures will be negative. Acute viral gastroenteritis caused by Rotavirus, Norwalk agent, or Adenovirus may provoke exacerbation of preexisting CD.[16] The latter has also been observed with Rubella virus and Epstein-Barr virus infection.[17] Bloody diarrhea indicates a break in the mucosal lining and is often of bacterial origin. Stool cultures can confirm the bacterial nature of the diarrhea, but are frequently negative. In this setting, one must also consider diverticular disease, ischemia, malignancy, and drug-induced colitis.[18] A diagnosis of CD must be made cautiously in a patient with a first attack of colitis. Most patients with infectious colitis experience an acute onset of the disease and present within 1 week, often with fever. Onset of diarrhea in IBD is more often insidious.[19] A positive stool culture does not necessarily exclude a diagnosis of IBD.[20] Histology may assist in the differential diagnosis because focal basal plasmacytosis is a good predictive factor for a diagnosis of IBD. If acute colitis remains unclassified, patients should be followed up because up to 50% may develop IBD within 2.5-3 years.[21]

Not an answer but maybe getting warmer?
 
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