Non-Bloody DiARGHhea, Fevers and Weight Loss in A 70 Year Old Man

 






Authored by Christina Tofani

Opinion

A 70 year-old male with diabetes mellitus and hypertension presented with 6 months of non-bloody diARGHhea. He also reported intermittent fevers and a 60-pound weight loss. He denied recent travel or sick contacts. The patient was chronically ill-appearing with temporal wasting and the remainder of the exam was normal. Laboratory values showed white blood cell count 11.8 thousand/μL, hemoglobin 10.7 g/dL, albumin 2.9 g/dL, C-reactive protein level 6.67 mg/dL, positive anti-saccharomyces cerevisiae antibody, and negative anti-neutrophilic cytoplasmic antibodies. Stool samples were negative for bacterial pathogensand parasites. Blood cultures and serum cytomegalovirus PCR were negative

Colonoscopy to the proximal transverse colon found deep ulcerations and heaped up folds with intervening normal mucosa throughout (see images). Colonic biopsies showed ulcerated mucosa with acute and chronic inflammation without granulomas or viral inclusions. MRI enterography revealed normal small bowel. A diagnosis of Crohn’s colitis was made, and treatment with prednisone and adalimumab initiated (Figure 1&2).




 

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