Q. What is the cause of my symptoms, diabetes or Crohn's disease?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Aug 11, 2020 and last reviewed on: Sep 03, 2020

I am a 22 year old male. I am 5 foot 7 inches and weigh about 150lb (Currently; used to weight about 175lb). I don't smoke, drink or use recreational drugs. I have some pre-existing medical issues for several years (acne, anal itching/jock itch, and sometimes have stomach cramps after eating and have the urge to defecate/urinate almost right away) and don't use any medications.

Over the past few years (more noticeably in the recent 12 months), I have been losing weight quickly without much effort (I don't workout that much, just cycling and walking) and have loss of apetite as well.

I was experiencing abdominal pain that would originate in the abdominal area and would sometimes extend to the back (sometimes as far as up to between my shoulder blades).

I also experienced frequent urination and noticed that my urine was dark brownish and when I flush, it would bubble up and appear foamy for a bit. I also had a white tongue (which I figured must be most likely Oral Thrush). On my ankles, I had these brown spots and on my shins I had some spots as well. they itch at times and I thought this was diabetic dermopathy.

I also had alternating periods of loose, porridge like, fatty stools (brownish/orange) or diarrhea that was light yellow/brown/orange. Moreover, my breath smells funny (I am not sure if its ammonia, ketones, halitosis, or something else) but it smells like urine/rotten things.

I searched it up, and most results point to type 2 diabetes, which I thought should be a reasonable explanation. Hence I decided to reach out to a walk in clinic and based on the advice of a physician, I was told to get a blood test &HIV test (to rule it out). I did end up getting the blood test after fasting for 12 hours and my Hb1AC was 5.2% and my fasting glucose was 4.3 mmol/L. The only result that was high in the blood test was total bilirubin levels (which was at 20 umol/L). The doctor told me that it is most likely IBD/IBS and that I should keep a food diary and note what upsets my and causes diarrhea. He also said a result of 20 for total bilirubin should not be too concerning, as the reference for concern was 20 umol/L or above.

Then I reached out to a physician again at the walkin clinic and was told to do an abdomen ultrasound to check my liver (as bilirubin was high). I did end up doing that as well, and the doctors said the ultrasound was normal and there was no sign of anything wrong. Then I reached out again to follow up on this, and the next doctor told me to get a urinalysis. I ended up getting it and everything appeared normal (Protein - negative, ketones- negative, glucose -negative) except for erythrocytes (which was at 0.3 mg/L) and a note on the result says the following "Borderline result for predicting hematuria. Repeat if clinically indicated.".

In general chemistry, total protein was 78 g/L (reference is 60-80) and albumin was 50 g/L (reference is 35-52). I feel this is very close to being high. Aside from this, in the random urine chemistry section, my ACR was reported. The albumin (urine) was at 13 mg/L and creatinine (urine) was high at 34 mmol/L (reference was 3.5-24.5). Finally the ACR ratio was 0.4 mg/mmol.

I grew anxious, and searched what it means to have high creatinine in urine. Results point to diabetes, muscle composition and kidney problems. I reached out today morning again to a doctor, to ask them what they think the cause might be based on blood test, ultrasound and urine test. The doctor was quick to dismiss my concerns and says that my symptoms mean COVID-19 and that I should self-isolate. I gave up at this point and was not sure of what I should do.

My guesses are its IBS/IBD (Crohn's or Ulcerative Colitis), Diabetes?, Celiac disease (have never been tested for this and am fairly tolerant towards gluten foods). I am somewhat lactose intolerant (Drinking dairy products gives me an upset stomach usually and I have to use the bathroom too at times. If you could also let me know what I should do about the anal itching/jock itch and the weird smell on my tongue (which a doctor previously told me must be bacteria and to just use salt water to gargle) would be helpful. Any advice regarding this situation would be appreciated. Thank you in advance.

#

Hello Dear. I welcome you to icliniq. Well you very well explained your symptoms..It was palatable to read, I must say. Well your concerns are genuine but here is my take on this.

You are too young to develop dm type 2, and dermatopathy is far far away to be even considered. Plus you have normal diabetes HBA1c. So no point to linger with this diagnosis anymore.

Lactose intolerance is common in almost 65% of adult population because the enzyme lactase get low in amount as the age advances. The best option is to avoid milk and milk based things.

Celiac is a possibility and should reasonably be excluded by simple blood test. I Will write for you. Crohns is the possibility especially in young, with abdominal pain and unusual weight loss, I would suggest you some stool testing, to at least somewhat make a sense whether it is present in you or not.

I cant figure out why you would have thrush. You probably have gone through reasons underlying thrush, the common is immunocompromised individual. Merely weight loss does not make you immunocompromised. Share with me the oral cavity while sitting in front mirror and with flash on, plus take that skin pigmentation picture, I may be in position to tell you what are those.

In last If we are able to exclude potentional causes, and still find you persist problem, IBS is always there to reasonably explain your symptoms. So for me it is early to say IBS.

Find investigations below.

If you have concern, you can reach out me using following link. icliniq.com/ajeetlohana regards


Investigations to be done:

anti ttg IgA and IgG
Serum IgA levels
Serum IgE
CRP and ESR
Stool detail report
stool for fecal calprotectin

Regarding follow up:

follow up with above investigations.


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