Crohn's Disease Initially Accompanied by Deep Vein Thrombosis and Ulnar Neuropathy without Metronidazole Exposure
A 35-year-old male patient visited emergency department, complaining of hematochezia with diarrhea for 2 days and a weight loss of more than 5 kg over the previous 3 months. Before he visited our hospital, he was managed intermittently in other hospital due to right calf pain for the past 4 months. On physical examination, he looked pale and skin rash was found on right calf. Left forearm paresthesia was noted on neurologic examination. He denied smoking and has been worked as an office manager. We could not find any risk factors for DVT on his past medial history. Colonoscopic examination showed multiple ulcerations near the ileocecal valve, which was compatible with CD (). Histologic examination revealed granuloma. The CD activity index was 191 at initial diagnosis.\nOn admission, physical examination revealed moderate right calf erythema, tenderness, and positive Homan's sign. Lower extremity computed-tomography angiogram confirmed the presence of DVT (). Laboratory tests were unremarkable except for decreased hemoglobin (12.1 g/dL) and elevated C-reactive protein (47.96 mg/L). The tests for hypercoagulable states including cardiolipin immunoglobulin G/immunoglobulin M, lupus anticoagulant, β2-glycoprotein I antibody, plasminogen activator inhibin, thrombin time, antithrombin III, factor V/VIII, factor V Leiden, and homocysteine were within the normal range.\nSensory nerve conduction examination of the left ulnar nerve showed low sensory nerve action potential, which was compatible with ulnar nerve mononeuropathy ().\nMesalamine and folic acid treatment was initiated and warfarin was administered after heparinization. Rehabilitational support for ulnar nerve mononeuropathy was also initiated. Left forearm paresthesia has been disappeared with the improvement of CD activity index down to 36. The patient's condition improved and was discharged 2 months later.