S4892 Concurrent Presentation of Crohn’s Disease & Sickle Cell Crisis in an 18-Year-Old Man: A Case Report

Introduction: The co-occurrence of Crohn's disease (CD) and sickle cell disease (SCD) presents diagnostic challenges, as 30% of SCD patients experience GI symptoms mimicking CD flares. With 100,000 SCD patients in the U.S., this overlap complicates management, often delaying diagnosis (40% of cases) and leading to inappropriate steroid use (62%). We present an 18-year-old man with quiescent CD (Paris A1bL1L2B1) whose SCD crisis mimicked a CD flare, highlighting the critical role of clinical evaluation to differentiate these conditions & guide therapy in this high-risk population. Case Description/Methods: An 18-year-old man with known Crohn's disease (Paris A1bL1L2B1 phenotype) presented with acute abdominal pain, vomiting, & profound hypotension (78/54 mmHg). Initial labs revealed critical pancytopenia (Hb 5.3 g/dL, WBC 2450, platelets 83,000), AKI (Cr 4 mg/dL), & metabolic acidosis (pH 7.30). Positive sickling test confirmed previously undiagnosed SCD. After packed RBC transfusion (Hb improved to 7.3 → 10.5 g/dL) & intravenous hydration (Cr normalized to 0.8 mg/dL), colonoscopy showed quiescent Crohn's (SES-CD 2, Modified Mayo 1) without active inflammation. Multidisciplinary care (GI/hematology/nephrology) avoided immunosuppression per ACG-modified protocols, achieving clinical stabilization within 7 days. Discussion: This case throws some light on the diagnostic complexity of Crohn's-SCD overlap, where vaso-occlusive crises (Hb 5.3 → 10.5 g/dL, hypotension 78/54 mmHg, AKI Cr 4 → 0.8 mg/dL) perfectly mimicked inflammatory bowel disease (IBD) flare. Endoscopic evaluation (SES-CD 2, Modified Mayo 1) proved critical to confirm quiescent Crohn's and avoid harmful immunosuppression per modified ACG criteria (Hb <7 g/dL threshold). Three key insights were noted including 1. IBD-like symptoms in SCD patients demand endoscopic verification before biologics/steroids, 2. Multidisciplinary co-management (GI/hematology/nutrition) is essential to balance competing risks (e.g., anti-tumor necrosis factors during crises may worsen outcomes), and 3. Unexplained anemia (Hb <7 g/dL) in young IBD patients should prompt SCD screening. These findings directly inform ACG guideline gaps, proposing protocolized endoscopic assessment for this high-risk population. The case establishes a new management realm where endoscopic activity confirmation precedes immunosuppression in patients with a dual diagnosis, preventing iatrogenic harm while optimizing IBD control.