Case 03

Created by HELENE MOULIN on Jul 18, 2017 4:58:22 PM, Last modified by HELENE MOULIN on Jul 18, 2017 5:14:20 PM
 
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Clinical information

  • A 70-year old woman presented with 3 weeks of diarrhea following Augmentin therapy for a dental procedure. She was presumed to have antibiotic-associated diarrhea and was empirically treated with metronidazole and vancomycin despite negative assays for C. difficile. Endoscopy was performed, revealing a normal colon and a nodular ileum with numerous ulcers, suspicious for Crohn disease. An ileal biopsy was obtained (A). Based on the findings, the patient was and treated with prednisone and 6-mercaptopurine. Her symptoms completely resolved, but she developed pain with defecation approximately 4 weeks after presentation. Examination revealed an anal fissure that was treated symptomatically and resolved. After a symptom-free period, she developed bloody diarrhea toward the end of a steroid taper. A sigmoidoscopy was performed, revealing granularity and ulcers, which were biopsied (B).

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1 
RYantiss JFMC17 Case 3A
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2 
RYantiss JFMC17 Case 3B
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