Multiple Splenic Lesions as the First Manifestation of Crohn Disease in a 13-Year-Old Boy

Multifocal splenic lesions are rare in the pediatric population, usually arising from infectious or inflammatory conditions. They have been described as an extraintestinal manifestation of inflammatory bowel disease, particularly Crohn Disease (CD), in patients with long-standing illness, but are rarely reported as an initial manifestation, especially in children. We present a case of a previously healthy 13-year-old boy admitted with a 25-day history of intermittent left upper quadrant pain. An abdominal ultrasonography performed 2 days before admission revealed splenomegaly with multiple hypoechoic nodules, findings confirmed by abdominal magnetic resonance imaging. Despite broad-spectrum antimicrobial therapy, there was no clinical improvement. Extensive diagnostic workup yielded negative results, and an initial lower gastrointestinal endoscopy showed no specific findings. However, 6 months later, a repeat colonoscopy confirmed CD. This case highlights the importance of considering inflammatory bowel diseases, particularly CD, when evaluating unexplained splenic nodules. Early recognition and conservative management are crucial to avoid unnecessary splenectomy, particularly in pediatric patients.