Nawracające zakażenie układu moczowego jako pierwszy objaw choroby Leśniowskiego i Crohna

Abstract Crohn's disease belongs to the group of autoimmune diseases, known as inflammatory bowel disease. The inflammation may span the entire depth of the intestinal wall. In effect the typical complications of Crohn's disease can be the formation of fistulas: external (perianal, between the bowel and skin) and internal (between two loops of bowel, between the bowel and bladder, between the bowel and vagina). These complications may occur in about 30–40% of patients. The study describes a 17-year-old patient hospitalized for recurrent urinary tract infections. The first symptoms of the disease were tonic abdominal pain, anemia, recurrent diarrhea, fever of unknown etiology. The cause of these problems was a urinary tract infection, which persistently recurred despite aggressive treatment. After the transfer to the Department, the diagnostic process revealed the suspicious thickening of the walls of the ileum. The diagnostics was expanded in the direction of inflammatory bowel diseases. In addition to urinary tract infections, Crohn's disease was diagnosed and confirmed. Owing to persistent dysuria, a fistula between the bowel and bladder was suspected. After confirmation of this diagnosis a parenteral nutrition was applied and the treatment was continued in the Department of Gastroenterology. This case illustrates the potential difficulties in identifying the cause of urinary tract infections and shows the need for an accurate diagnostic process, especially in cases of recurrent. The cause can sometimes be very surprising.