Diagnóstico tardio de Doença de Crohn Fibroestenosante-Fistulizante: relato de caso
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Resumo
Objetivo: Relatar o caso de um paciente com atraso diagnóstico de 15 anos para Doença de Crohn (DC) Fibroestenosante-Fistulizante, diagnosticada em fase avançada com fístula entero-sigmoidea, descrevendo o curso clínico e as intervenções realizadas. Detalhamento do caso: Paciente masculino, 27 anos, tabagista, com relato de dor abdominal crônica associada a quadros diarreicos desde os 14 anos. Exames laboratoriais evidenciando elevação de provas inflamatórias e anticorpo anti-Saccharomyces cerevisiae (ASCA) positivo. Colonoscopia com alterações sugestivas de DC ativa e enteroressonância com regiões de estenose em íleo distal e fístula íleo-sigmoidea com indicação de abordagem cirúrgica. O paciente apresentou DC refratária à corticoterapia, demandando múltiplas otimizações terapêuticas e troca do imunobiológico de Infliximabe (IFX) para Adalimumabe (ADA) devido ao desenvolvimento de resistência imune ao IFX, com resolução cicatricial de fístula às custas de ampliação das áreas de estenose, mantendo padrões de exacerbação e remissão da doença. Considerações finais: O atraso diagnóstico de 15 anos devido aos sintomas inespecíficos, curso clínico intermitente e perda de seguimento do paciente, além do tabagismo, foram fundamentais para a progressão do processo inflamatório crônico e desenvolvimento de um perfil mais agressivo da doença.
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