Failure to thrive: A severe manifestation of interleukin 10 receptor A mutation in adult inflammatory bowel disease.

Background Very early onset inflammatory bowel disease (VEO-IBD) secondary to IL-10RA mutations have aggressive disease courses with increased nutritional needs compared to other monogenic forms of IBD. Presentation A 28-year old male was hospitalized at 18-days old for bloody diarrhea diagnosed as Crohn's disease at 6-months old. He showed failure to thrive and worsening inflammation while maintained on enteral nutrition (EN) and standard IBD treatment. He was hospitalized in 2016, at 28 years old, for a Chron's flare when sequencing confirmed a heterozygous mutation in IL10-RA. His weight and plasma micronutrient levels improved when transitioned to parenteral nutrition (PN). He was initiated on anakinra while awaiting hematopoietic stem cell transplant (HSCT) with substantial decrease in inflammation. He was able to gain weight, initiate an oral diet and decrease his PN requirement. Conclusions Our patient experienced progressive failure to thrive on EN. VEO-IBD incidence is rising and its diagnosis is often delayed. Therefore, prompt recognition with treatment initiation is essential to improving nutritional outcomes in this patient population. Further investigation is warranted to determine if these patients would benefit from early initiation of PN. This article is protected by copyright. All rights reserved.