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Crohn's ? -- Need Help!

My son(14 yrs old) started seeing some blood in his stool without having any pain in the abdomen or having diarrhea ( 2 times poop max a day). No fever.
His symptoms lasted for a month n half and we would see blood not on a daily basis. He had some hammeroids too before he started seeing blood stained poop.

He did the blood work and saw high CRP, fecal calprotectin level.
We are asked to go for endoscopy and colonoscopy and then biopsy. (report is as below). He did see some small individual ulcers (10-12 in terminal ileum and 3-4 in cecum and some inflammation in cecum)
After biopsy doctor confirmed that its crohns as he could see granulomas in biospy
I have searched up a lot after that and found that you need to have certain types of granulomaso have crohns.

A: Random duodenum biopsy:
No significant/diagnostic histologic abnormalities.
No significant intraepithelial lymphocytosis.
No villous blunting.
No evidence of Giardia.

B: Stomach biopsy:
No significant/diagnostic histologic abnormalities.
No H. pylori organisms identified on HE.
No evidence of intestinal metaplasia or dysplasia.

C: Terminal ileum biopsy:
Focal active ileitis and focal crypt architectural distortion identified
adjacent to lymphoid hyperplasia.
No granulomas or dysplasia.

D: Cecum biopsy:
Focal acute ulceration.
Poorly formed granulomas identified.
Negative for dysplasia.

See comment.
E: Random colon biopsy:
No significant/diagnostic histologic abnormalities.
No granulomas.
Negative for dysplasia.

F: Rectosigmoid colon biopsy:
Focal mild active proctocolitis.
No diagnostic evidence of chronic proctocolitis.
No granulomas or dysplasia.

G: Rectum biopsy:
Focal minimal chronic active proctitis.
No granulomas.
Negative for dysplasia.

The findings of ileocecal erosion/acute ulceration, focal active ileitis, focal active proctocolitis, and focal chronic proctitis raise a differential diagnosis of infectious enterocolitis, drug/toxin induced
enterocolitis, inflammatory bowel disease, and enterocolitis secondary to vasculitis/connective tissue disease, among others. Clinical correlation is recommended.

Since prominent lymphoid proliferation is noted in the terminal ileum biopsy, a battery of immunostains are performed. The lymphoid population is composed of a mixed T cells and B cells with B cells
slightly overrepresented. No coexpression of CD10 is seen on B cell population. Cyclin D1 is negative. Ki67and CD21 highlight germinal centers. No coexpression of BCL2 and BCL6 is noted. No diagnostic
evidence of lymphoma is identified immunohistochemically on the selected panel.

AFB stain and GMS stain performed on block D1 are negative for acid-fast bacilli and fungal elements, respectively. Control tissue shows appropriate staining. Since AFB stain has a low sensitivity on tissue
section, negative staining does not entirely rule out infection.

Clinical correlation is recommended.

NOTE: ANY help will be grateful.

my little penguin

Staff member
Only 30% of crohns patients have non caseating granulomas found on biopsy
So you can have crohns without the “right “granulomas
You can most certainly have crohns without diarrhea or abdominal pain
Your child’s biopsy results showed a lot of inflammation
So unfortunately crohns
Age 14 is pretty typical age for pediatric crohns

you can get a second opinion by having the biopsy slides abd imaging sent to a university based pediatric hospital
If in the US
children’s of Philadelphia (chop )
Boston childrens
Cinnicinati childrens (cchmc )

my kiddo was dx at 7
No diarrhea-scope looked normal
Biopsy not so normal -
He is 18 now and just sees the Gi twice a year
So not too much of an issue once things are under control
Scary at first
But with the right med combo
Normalcy can be obtained
As well as growth /weight

give your self time grieve
It's a diagnosis that is so hard to accept. At 14, maybe your son will be interested in learning along with you and preparing from an early age to advocate for himself in a medical setting. My son who has Crohn's is also 14 (although his diagnosis was 5 years ago now). I wish he was more interested in his health! The most important thing to him is his growth and development at this age. Fortunately he has a medication which works for him and his growth is on track. He takes Humira and 2-3+ meal replacement shakes each day plus whatever food he can tolerate.

my little penguin

Staff member
My kiddo has tried it all
Currently takes Stelara plus methotrexate and 2 meal replacement shakes a day with a ton of food
The meds are for his crohns and his juvenile arthritis (especially methotrexate)