Non-Bloody DiARGHhea, Fevers and Weight Loss in A 70 Year Old Man
Christina Tofani* and David Kastenberg
Thomas Jefferson University Hospital, USA
Submission: February 01, 2017; Published: February 14, 2017
*Corresponding author: Christina Tofani, Thomas Jefferson University Hospital, 909 Walnut St, Philadelphia, PA 19107, USA, Email;christina.tofani@gmail.com
How to cite this article: Christina T, David K. Non-Bloody DiARGHhea, Fevers and Weight Loss in A 70 Year Old Man. Adv Res Gastroentero Hepatol 2017; 3(1): 555605. DOI: 10.19080/ARGH.2017.03.555605
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).