This imaging pattern â circumferential small bowel wall thickening (jejunum + ileum), prominent vasa recta (comb sign), mesenteric fat stranding, discrete mesenteric lymph nodes, and minimal ascites â is very characteristic of Crohn's disease, particularly given your autoimmune background and young age. Intestinal tuberculosis must also be strongly considered in an Indian patient as it can be radiologically identical. These two conditions need to be differentiated before starting treatment, as the management differs significantly â steroids used in Crohn's can worsen TB.
Next Steps
Urgent gastroenterology referral. Get colonoscopy with terminal ileum intubation and biopsies (for granulomas, AFB staining). Also: IGRA/Mantoux, stool CBNAAT,
CRP, ESR, stool calprotectin, and ASCA/p-ANCA. MRI enterography will better characterize the small bowel involvement.