Gastro-colic Fistula-associated Hypersplenism Causes Pancytopenia in a Patient with Crohn's Disease

Seisuke Saito; Nobuhiro Ueno; Yuki Kamikokura; Yuya Sugiyama; Yu Kobayashi; Yuki Murakami; Takehito Kunogi; Takahiro Sasaki; Keitaro Takahashi; Katsuyoshi Ando; Shin Kashima; Kentaro Moriichi; Hiroki Tanabe; Mishie Tanino; Toshikatsu Okumura; Mikihiro Fujiya

doi:10.2169/internalmedicine.9590-22

CASE REPORTS

Gastro-colic Fistula-associated Hypersplenism Causes Pancytopenia in a Patient with Crohn's Disease

Seisuke Saito, Nobuhiro Ueno, Yuki Kamikokura, Yuya Sugiyama, Yu Kobayashi, Yuki Murakami, Takehito Kunogi, Takahiro Sasaki, Keitaro Takahashi, Katsuyoshi Ando, Shin Kashima, Kentaro Moriichi, Hiroki Tanabe, Mishie Tanino, Toshikatsu Okumura, Mikihiro Fujiya

Author information

Seisuke Saito
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Nobuhiro Ueno
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Yuki Kamikokura
Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Japan
Yuya Sugiyama
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Yu Kobayashi
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Yuki Murakami
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Takehito Kunogi
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Takahiro Sasaki
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Keitaro Takahashi
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Katsuyoshi Ando
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Shin Kashima
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Kentaro Moriichi
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Hiroki Tanabe
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Mishie Tanino
Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Japan
Toshikatsu Okumura
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Mikihiro Fujiya
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan

Keywords: Crohn's disease, pancytopenia, hypersplenism, gastro-colic fistula, splenomegaly

JOURNAL OPEN ACCESS

2023 Volume 62 Issue 1 Pages 69-74

DOI https://doi.org/10.2169/internalmedicine.9590-22

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Abstract

A 24-year-old woman was admitted to our hospital due to abdominal pain and a high fever. She was diagnosed with ileocolonic Crohn's disease (CD), complicated with a gastro-colic fistula and splenomegaly. After initial treatment with an infliximab-biosimilar, all blood cell line counts markedly decreased. Three-dimensional reconstructed computed tomography revealed splenic vein narrowing. Thus, her pancytopenia was deemed to have likely been caused by hypersplenism. Surgery was performed, and clinical remission was maintained without pancytopenia. This is the first report of a CD patient with pancytopenia caused by hypersplenism that was triggered by gastro-colic fistula-associated splenic vein obstruction.

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