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Inflammatory Bowel Disease.

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I moved to Cameroon, Africa in August of 2013. In January 2014, I had a bout of diarrhea (not unusual) but along with the diarrhea came really bad pains in my upper abdomen which was unusual. The pain was localized in the same spot and came in waves. Within 24 hours I was back to normal. Then on Feb 8 I had the diarrhea pains again along with a mild fever. Again it went away within 24 hours. The next week, Feb 15, it happened again. And then again on March 1. Now the last one, March 1, was different than the other times. This time the pains continued long after the diarrhea stopped, I had pain for an additional two days with the last day being a more constant pain felt worse when standing/walking around.

That's when I knew it was time to go to the doctor. I went to a French clinic and she was pretty sure I had some kind of parasite or issue with my liver. I went to get blood work done and to have a stool culture and check for parasites. There was no parasite (checked on two separate days) and the only things the tests showed were: A small amount of yeast in the stool and a C-reactive protein amount of 24.98 mg. The doctor didn't feel that either of those was the cause of my diarrhea and pain issues. Now yesterday I woke up with a rash on my neck. It's just a small section of itchy, raised bumps. Today I noticed it has spread onto the bottom of my face. I have no benedryl to take otherwise I would have taken it to see if it would help.

I have no clue if all of this is related or completely separate issues. My concern is with the elevated C-reactive protein. In the last two weeks I have changed my diet to include more vegetables in the hopes that a diet change would prevent the diarrhea. Nothing else has changed, no change in soap, no new foods I've never had before, etc.

About me. I'm a 40 year old woman in pretty good health. I rarely ever got sick back in the states. The last time I went to see the doctor was a couple of years ago when I had pneumonia. I drink wine 3-4 times a week and smoke about 4-5 cigarettes per day. I weigh about 200 pounds (was 260 pounds 7 years ago, lost weight and got down to 156. Within the last year I went up again). I've been working out 2-3 times per week and am struggling to lose pounds. I drink anywhere from 2-3 liters of water per day, more on days I workout. I am a teacher in Yaounde the capital city and live in an apartment provided by the school. I cook some of my meals and my other meals are prepared for my by a local lady and the cook at the school. I do not eat food prepared on the streets and only eat out at places that have been recommended by other teachers. My cook knows how to prepare food properly as she has worked for Americans for many years.

I plan on going back to the French doctor this week but would like to be able to suggest some possible tests they could run to see what this is I'm dealing with. Please let me know if there are additional things I can tell you to help you figure out what this might be. I have the test results from the work I've had done but it's all in French.

Category: Internal Medicine Specialist

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Category: HIV- AIDS Specialist
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Hello and thankyou for approaching DoctorSpring with your query.
I have gone through you case and understand your concern.
From the evaluation of the symptoms it is probable that you have something known as Inflammatory Bowel Disease (IBD). Patients with IBD complain of crampy abdominal pain with diarrhea, urgency, constipation, alternating diarrhea and constipation, or normal bowel habits alternating with either diarrhea and/or constipation.
It can present at any age. C-Reactive protein is raised in case of Inflammatory Bowel Disease.

The yeast in you stool is nothing to worry as it is a part of the intestinal flora. You skin rash is less likely to be related to the IBD based on the symptoms you have described of the rash. It could probably be due to an allergy. I would advise you to continue benadryl for the same.

You will require to get a few tests to make a definite diagnosis of your condition. Since you have already got a few tests, you need not repeat them if they have been done. The tests include
1) Complete Blood Count with ESR
2) Endoscopy with biopsy
3) CT Abdomen or MRI

Depending on these tests you may further require to get further investigations like, Blood electrolytes, Serum iron and B12 levels, Renal function tests, liver function tests.

I hope this has helped. Feel free to follow up.
Thankyou



Patient replied :

Thank you. I just have one additional question if you don't mind. I had another blood analysis done and it indicate a sed rate of 20mm in the 1st hour and 50mm in the second hour. Is this common in IBD? Or something else?



Hello and thankyou for getting back to me.
Yes, it is common in IBD. Your ESR levels are raised and it is commom to have raised ESR levels even upto >30mm/hr. C Reactive protein levels are also raised in IBD.
Do get the other tests mentioned when possible depending on which appropriate treatment can be started.

Till then you can try a few lifestyle and diet modifications mentioned below.
1) Avoid dairy and dairy products
2) Avoid smoking and alcohol, caffeine and carbonated drinks.
3) Avoid spicy food and food that causes a lot of gas like beans, lentils, cabbage, broccoli
4) Drink a lot of water

I hope this has helped.
Wishing you good health.
Thankyou


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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