ELECTRONIC CLINICAL CHALLENGES AND IMAGES IN GI An Uncommon Cause of Abdominal Pain and Fever in a Patient With Crohn’s Disease John D. Wysocki,1 Samar M. Said,2 and Konstantinos A. Papadakis2 1
Tulane University School of Medicine, New Orleans, Louisiana; 2Mayo Clinic College of Medicine, Rochester, Minnesota
Question: A 46-year-old man with a history of ileocolonic Crohn’s disease (CD) presented with worsening abdominal and back pain, fever, and headache. He was diagnosed with CD 16 years ago, when he presented with suspected perforated appendicitis and found to have free intraperitoneal perforation from Crohn’s ileitis for which he underwent ileocecal resection. He did well postoperatively for about 10 years. He developed recurrent CD and was treated with infliximab and azathioprine until 5 months ago, when he developed periumbilical abdominal pain and back pain. Computed tomography (CT) of the abdomen was unremarkable at that time. His treatment regimen was switched to adalimumab and later to certolizumab pegol, without improvement of his symptoms. One month ago, he had worsening pain, fever, unintentional weight loss, and a progressively worsening headache, which prompted hospital admission and further evaluation. Laboratory studies showed a white blood cell count of 7.8 109/L with 89% polymorphonuclear neutrophils and an elevated C-reactive protein (163 mg/L; normal,
Tulane University School of Medicine, New Orleans, Louisiana; 2Mayo Clinic College of Medicine, Rochester, Minnesota
Question: A 46-year-old man with a history of ileocolonic Crohn’s disease (CD) presented with worsening abdominal and back pain, fever, and headache. He was diagnosed with CD 16 years ago, when he presented with suspected perforated appendicitis and found to have free intraperitoneal perforation from Crohn’s ileitis for which he underwent ileocecal resection. He did well postoperatively for about 10 years. He developed recurrent CD and was treated with infliximab and azathioprine until 5 months ago, when he developed periumbilical abdominal pain and back pain. Computed tomography (CT) of the abdomen was unremarkable at that time. His treatment regimen was switched to adalimumab and later to certolizumab pegol, without improvement of his symptoms. One month ago, he had worsening pain, fever, unintentional weight loss, and a progressively worsening headache, which prompted hospital admission and further evaluation. Laboratory studies showed a white blood cell count of 7.8 109/L with 89% polymorphonuclear neutrophils and an elevated C-reactive protein (163 mg/L; normal,
