Journal List > Korean J Gastroenterol > v.55(1) > 1006689

Park, Kim, Ye, Byeon, Myung, Yang, Kim, and Chi: A Case of Monozygotic Twins with Crohn's Disease

Abstract

Although the incidence and prevalence rates of IBD in Korea are still lower than Western populations, they have been increasing rapidly during the past decades. Crohn's disease (CD) tends to run in families because it is thought to be related to genetic susceptibility coupled with environmental factors. A large number of monozygotic and dizygotic twin pairs with inflammatory bowel disease have been reported in western countries. The population relative risk in first-degree relatives is considered to be about equal in both Koreans and westerners. To our best knowledge, there is no report in monozygotic twins with CD in Korea. This case report is the first documented occurrence of concordant CD occurring in monozygotic twins in Korea.

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Fig. 1.
Abdomen CT findings. (A) Twin-1, mesenteric inflammatory mass with small abscess cavity was accompanied by fistula tract connected with the ileum (black arrow). (B) Twin-1, stricture was seen in the pelvic ileum (black arrow). (C) Twin 2, multifocal segmental bowel wall thickening was seen in the ileum (black arrow).
kjg-55-68f1.tif
Fig. 2.
Colonoscopic findings. (A) Twin-1, multiple ulcers with exudates were noted in the terminal ileum. (B) Twin-2, multiple ulcers with exudates were noted in the terminal ileum.
kjg-55-68f2.tif
Fig. 3.
Small bowel series findings. (A) Twin-1, segmental edematous wall thickening was seen in pelvic ileum (black arrow). (B) Twin-2, bowel wall thickening was seen in the ileum (black arrow).
kjg-55-68f3.tif
Fig. 4.
The pedigree of patients. In second-degree family, only twins have Crohn's disase, and the others do not have inflammatory bowel disease.
kjg-55-68f4.tif
Fig. 5.
Monozygotic twins proven by AmpFLSTR IdentifierTM PCR Amplification kit. PCR of 16 STR concurred in twins. (A, C) Twin-1, (B, D) Twin-2.
kjg-55-68f5.tif
Table 1.
Clinical Characteristics of Twins with Crohn's Diseas (Based on Montreal classification8)
Twin 1 (younger brother) Twin 2 (older brother)
Sex Male Male
Height 170 cm 169 cm
Weight 45 kg 50 kg
Age at diagnosis A1 (15 years) A1 (15 years)
Location (L) L3 L3
(small bowel (small bowel
and colon) and colon)
Behavior (B) B3 (penetrating) B1
(nonstricturing,
nonpenetraing)
Extraintestinal None None
manifestation
Smoking history Smoker (1 py) Smoker (1 py)
Appendectomy Not done Not done
treatment
Remission Antibiotics Corticosteroid
induction
Remission Azathioprine Azathioprine
maintenance (1.5 mg/kg) (2 mg/kg)
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