Navigating a Complex Clinical Conundrum: The Coexistence of Crohn’s Disease, Celiac Disease, and Ankylosing Spondylitis

Abstract

The coexistence of Crohn’s disease (CrD), celiac disease (CD), and ankylosing spondylitis (AS) is exceptionally rare and poses significant diagnostic and therapeutic challenges. We report the case of a 27-year-old woman with alpha-thalassemia and a nonspecific genetic disorder, who presented with chronic diarrhea, severe weight loss, and Koenig syndrome. Laboratory results confirmed malabsorption syndrome, anemia, hypoalbuminemia, and elevated inflammatory markers, with colonoscopy and biopsies diagnosing CrD and CD. Six months later, she developed peripheral arthritis, leading to a diagnosis of AS. Treatment with corticosteroids, azathioprine, a gluten-free diet, and infliximab led to clinical remission. This case highlights the importance of a diagnostic approach in distinguishing overlapping autoimmune conditions and demonstrates the efficacy of infliximab in managing both gastrointestinal and rheumatologic manifestations.