All caecal ulcers is not Crohn's: Think Travel-Think again

A 29 year old male presented with sudden onset of right iliac fossa pain to the emergency department. He was experiencing recent change in bowel habits with lose stools and no rectal bleeding. His blood investigations revealed raised inflammatory markers with a C-reactive protein of 125 mg/l and white cell count of 14 X 109/L. Emergency diagnostic laparoscopy was performed for suspected acute appendicitis. This showed a normal appendix with erythematous and inflamed caecum with fibrin deposition and a small omental adhesion adjacent to it. An urgent colonoscopy showed a 2-3cm isolated ulcerated area in the caecum (Figure 1 and Figure 2) with normal Terminal ileum (Figure 3). Initial biopsies showed ulceration and chronic inflammation which raised a possibility of inflammatory bowel disease. He was reviewed in outpatient clinic and a further colonoscopic biopsy was arranged before embarking on steroid and immunosuppressive therapy, considering that he has travelled to India on two separate occasions prior to the onset of symptoms