Differential Diagnosis
The patient's symptoms of innumerable tiny focal areas of inflammation throughout the entire small bowel, larger erosions in the ileum with surrounding erythema, can be evaluated based on the following categories:
- Single most likely diagnosis
- Crohn's disease: Despite normal daily bowel movements, Crohn's disease is a strong consideration due to the presence of inflammation and erosions throughout the small bowel, particularly in the ileum. Crohn's disease can have a varied presentation, and the absence of typical symptoms like diarrhea does not rule out the diagnosis.
- Other Likely diagnoses
- Nonsteroidal anti-inflammatory drug (NSAID) enteropathy: Long-term use of NSAIDs can cause small bowel inflammation and erosions, similar to those described.
- Celiac disease: Although celiac disease typically presents with malabsorption and diarrhea, some patients may have atypical symptoms or normal bowel movements.
- Infectious enteritis: Certain infections, such as those caused by bacteria, viruses, or parasites, can lead to small bowel inflammation and erosions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Intestinal lymphoma: A rare but potentially life-threatening condition that can cause small bowel inflammation and erosions.
- Small bowel ischemia: Reduced blood flow to the small bowel can cause inflammation, erosions, and potentially life-threatening complications if not promptly addressed.
- Behçet's disease: A rare condition characterized by inflammation of blood vessels, which can affect the small bowel and cause erosions.
- Rare diagnoses
- Eosinophilic enteritis: A rare condition characterized by an accumulation of eosinophils in the small bowel, leading to inflammation and erosions.
- Chronic granulomatous disease: A rare genetic disorder that can cause recurrent infections and inflammation in the small bowel.
- Mastocytic enterocolitis: A rare condition characterized by an accumulation of mast cells in the small bowel, leading to inflammation and erosions.