Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract with relapsing and remitting episodes. Abscesses and fistulas are the most common presentations of anorectal Crohn’s disease. Antibiotics and surgical incision and drainage have been successful in treating perianal disease. We present here a 48-year-old woman with known case of Crohn’s disease who presented with massive swelling in the perianal region with severe throbbing pain and high-grade fever, 38.2°C; the surgeon noted a large perianal abscess near the anal verge with redness, hotness, and tenderness. One and a half months from perianal abscess surgery, culture sensitivity was done due to delayed wound healing and passage of greenish discharge, and it revealed highly resistant bacteria Proteus mirabilis, Escherichia coli, and Staphylococci. In conclusion, clinicians should be aware that abscess and fistula have a fair chance to develop in Crohn’s disease patients who are using immunomodulating and immunosuppressant therapy. In abscess and fistula cases, surgery should be determined as soon as possible, and close clinical monitoring should be performed. We recommend routine screening for enteric fistula and culture sensitivity of any discharge prior to the initiation of any antibiotic. Appropriate intervention should then be undertaken.
Case Rep Gastroenterol 2021;15:626–631

中文翻译：

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肛周病变术后瘘管克罗恩病的多药耐药性和急性发作

克罗恩病是胃肠道的慢性炎症性疾病，具有复发性和缓解性发作。脓肿和瘘管是肛门直肠克罗恩病最常见的表现。抗生素和手术切开引流已成功治疗肛周疾病。我们在此介绍一名 48 岁女性，她患有已知的克罗恩病病例，她的肛周区域出现大量肿胀，伴有剧烈的搏动性疼痛和高烧，体温 38.2°C；外科医生注意到肛门边缘附近有一个大的肛周脓肿，伴有发红、发热和压痛。肛周脓肿手术后一个半月，由于伤口愈合延迟和绿色分泌物通过而进行培养敏感性，结果显示出高度耐药的奇异变形杆菌，大肠杆菌和葡萄球菌。总之，临床医生应该意识到，在使用免疫调节和免疫抑制剂治疗的克罗恩病患者中，脓肿和瘘管有相当的机会发展。对于脓肿和瘘管病例，应尽快确定手术方式，并进行密切的临床监测。我们建议在开始使用任何抗生素之前，对肠瘘和任何分泌物的培养敏感性进行常规筛查。然后应进行适当的干预。
Case Rep Gastroenterol 2021；15:626–631