A 14-year-old boy experienced confusion and hallucinations that turned out to be caused by ulcerative colitis, a disease that inflames the intestines. Doctors initially thought his symptoms were unrelated to his digestive problems, but discovered the inflammation in his gut was affecting his brain. This case is unusual because confusion from gut disease is rarely seen in children. The boy didn’t improve with standard steroid treatment but recovered completely when given a special anti-inflammatory medication. This discovery suggests that severe gut inflammation can directly affect the brain and thinking in ways doctors haven’t commonly recognized in young patients.

The Quick Take

  • What they studied: Whether confusion and hallucinations in a young person could be caused by ulcerative colitis, a disease that causes inflammation and bleeding in the intestines.
  • Who participated: One 14-year-old boy who came to the hospital with two days of nonsensical speech and seeing things that weren’t there, along with loose stools.
  • Key finding: The boy’s confusion was caused by severe inflammation from ulcerative colitis, not by vitamin deficiencies or electrolyte imbalances as doctors might typically expect. He recovered completely after receiving anti-inflammatory treatment.
  • What it means for you: If a young person with gut disease develops confusion or strange behavior, doctors should consider that severe intestinal inflammation might be affecting their brain. This is rare but important to recognize. However, this is based on one case, so more research is needed before changing how doctors treat all patients.

The Research Details

This is a case report, which means doctors are describing what happened with one specific patient in detail. The 14-year-old boy came to the hospital complaining of talking nonsense and seeing hallucinations for two days. Doctors examined him carefully, checked his blood for vitamin and mineral problems, and performed neurological tests. Over time, his diarrhea got worse and started showing blood, which led doctors to diagnose him with ulcerative colitis—a disease where the intestines become inflamed and bleed.

The doctors first tried treating him with steroids, which are strong anti-inflammatory medicines commonly used for ulcerative colitis. When that didn’t work, they switched to a different type of medication called anti-TNF treatment, which targets a specific inflammatory chemical in the body. This new treatment worked, and the boy’s confusion completely disappeared.

Case reports are valuable because they describe unusual or unexpected situations that doctors haven’t seen before. They help alert the medical community to new possibilities and can lead to more research.

This case is important because it shows that confusion and hallucinations in children might sometimes be caused by gut inflammation rather than brain problems directly. Most doctors wouldn’t immediately think to check for ulcerative colitis when a young person presents with confusion. By documenting this case, doctors can now be more aware that severe intestinal inflammation can affect the brain and thinking in children, which is something rarely reported before.

This is a single case report, which is the lowest level of scientific evidence. It describes one patient’s experience in detail but cannot prove that this will happen to other patients. The strength of this report is that doctors carefully ruled out other common causes like vitamin deficiency and electrolyte problems. However, because it’s only one case, we cannot know how common this situation is or whether it will happen the same way in other children. More cases and research studies would be needed to confirm these findings.

What the Results Show

The main finding is that a 14-year-old boy presented with confusion, nonsensical speech, and hallucinations as his first symptom of ulcerative colitis. Doctors initially didn’t connect these brain symptoms to his gut disease because they found no vitamin deficiencies or electrolyte imbalances—the typical causes of confusion in patients with intestinal disease.

Over the following days, the boy’s diarrhea worsened and became bloody, which led to the diagnosis of ulcerative colitis. The inflammation in his intestines was severe enough to affect his brain function. When doctors treated him with steroids (the standard first-line treatment), his confusion didn’t improve. However, when they switched to anti-TNF medication—a stronger anti-inflammatory treatment—his symptoms completely resolved.

The doctors concluded that the inflammation itself, rather than nutritional deficiencies, was causing the brain symptoms. This suggests that severe gut inflammation can directly affect the brain through inflammatory chemicals and immune responses, not just through vitamin or mineral loss.

The case also demonstrates that standard steroid treatment doesn’t always work for all patients with ulcerative colitis, and some patients may need stronger anti-inflammatory medications. The boy’s complete recovery with anti-TNF treatment shows that targeting the underlying inflammation more aggressively can resolve even unusual neurological symptoms. The normal neurological examination despite the presence of confusion and hallucinations was also notable, suggesting the brain dysfunction was temporary and reversible.

Confusion and delirium have been reported in elderly patients with ulcerative colitis and in patients hospitalized for long periods, but this appears to be the first documented case in a child where confusion was the initial presenting symptom. Previous research has shown that vitamin B1 (thiamine) deficiency can cause a serious brain condition called Wernicke’s encephalopathy in patients with inflammatory bowel disease, but this boy didn’t have that deficiency. This case suggests a different mechanism—that inflammation itself can cause brain symptoms in children, which is a new observation in medical literature.

This is a single case report, so we cannot determine how common this situation is or whether it will occur in other children with ulcerative colitis. We don’t know if certain factors made this boy more susceptible to brain symptoms from his gut inflammation. The case doesn’t tell us whether other children with similar presentations would respond the same way to anti-TNF treatment. Additionally, we don’t have long-term follow-up information about whether the boy remained symptom-free or if there were any recurrences. More research with multiple patients would be needed to understand how often this happens and who is at risk.

The Bottom Line

Healthcare providers should consider ulcerative colitis as a possible cause when children present with confusion or hallucinations, especially if they also have gastrointestinal symptoms. If standard steroid treatment doesn’t improve neurological symptoms in a child with ulcerative colitis, stronger anti-inflammatory medications like anti-TNF therapy may be considered. However, these recommendations are based on a single case, so they should be discussed with a doctor on an individual basis. (Confidence level: Low—based on one case report)

This finding is most relevant to pediatricians, gastroenterologists, and neurologists who care for children with inflammatory bowel disease. Parents of children with ulcerative colitis should be aware that unusual behavioral or mental changes could potentially be related to their child’s gut disease. However, confusion in children has many possible causes, and this is a rare presentation. Children experiencing confusion should see a doctor for proper evaluation.

In this case, the boy’s confusion resolved completely once anti-TNF treatment was started, though the exact timeline for improvement wasn’t specified in the report. Recovery from brain symptoms related to inflammation may vary depending on the severity and how quickly treatment is started. Realistic expectations would be improvement over days to weeks once appropriate anti-inflammatory treatment is begun.

Want to Apply This Research?

  • Users with ulcerative colitis should track both gastrointestinal symptoms (frequency and consistency of stools, presence of blood) and neurological symptoms (mood changes, confusion, difficulty concentrating, sleep quality) to help identify any patterns or correlations between disease flares and mental changes.
  • If you have ulcerative colitis and notice unusual confusion, mood changes, or difficulty thinking clearly, log these symptoms in your app and contact your doctor immediately. Don’t assume these are unrelated to your gut disease. Keep detailed notes about when these symptoms occur relative to your digestive symptoms.
  • Establish a baseline of your normal mental clarity and mood when your ulcerative colitis is well-controlled. Then monitor for any changes during disease flares. Track the timing of any neurological symptoms alongside gastrointestinal flares to help your healthcare team identify patterns and adjust treatment if needed.

This case report describes one patient’s experience and should not be used to diagnose or treat any condition. Confusion and hallucinations have many possible causes and require proper medical evaluation. If you or someone you know experiences confusion, hallucinations, or unusual mental changes, especially in the context of gastrointestinal disease, please consult with a qualified healthcare provider immediately. This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.