Crohn's disease

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Step 1: View clinicals

A 42 year old man presents with numbness and a tingling sensation in both lower limbs, associated with generalised weakness and fatigability for 3 months. He also experienced occasional malodorous, bulky stools and lost 8 kg of weight during the preceding year. There was no history of alcohol abuse, rectal bleeding, or joint pains. His full blood count shows a Hb of 8.7 g/dL and MCV of 112 fL. A blood film shows a megaloblastic anemia with hypersegmented neutrophils.


Step 2: Order all relevant investigations

Serum B12 + Folate

Serum Vitamin B12: 150 pg/ml (200-900) Serum Folate: 5 ng/ml (5-16)

Stool full report

No amoeba, ova or cysts identified No pus cells or erythrocytes Bacterial and protozoal cultures: negative Fecal fat analysis: 7g/24h (2-6)

Lower GI endoscopy & biopsy

There is mucosal inflammation with friability and granularity from the ileum to ascending colon. There are multiple, deep serpiginous ulcerations located transversely and longitudinally. The biopsies are suggestive of Crohn’s disease.

Serum Albumin

30 g/L (35-55)


Step 3: Select appropriate management

Budesonide
NSAIDS
Vitamin B12
Surgical Resection


Score: ★★☆