A 10 year old boy with Down’s syndrome.
Presented with pain abdomen for 6 months.
CT abdomen showed jejunal and ileo-cecal thickening.
Colonoscopy showed ileal stricture.
Biopsy showed chronic active inflammation, no granuloma.
Mantoux test, TB Quantiferon - negative.
Next step?
Anti-tubercular therapy trial
Start oral steroids
Start biologics
Do enteroscopic biosy from jejunal thickening
