Case 4.2

Basic labs show: CBC 5.4>12<345 BMP/LFTs unremarkable ESR 20, CRP 9.3

This patient has known ileial disease which may be incompletely evaluated with a fecal calprotectin.

6TG = 352

While ruling out infection is often prudent in patients with IBD, there has been no acute change in his symptoms, which suggests a more likely explanation is inadequately treated inflammation. Infectious studies were not checked in this case.

MR enterography shows slight interval improvement of the ileal disease, now with about 10 cm involved. There remains no signs of fistula or abscess.

Colonoscopy after 6 months induction with prednisone and now azathioprine therapy can be useful to restage his disease. If he has ongoing disease, he can be escalated to biologic therapy. If he has improving or resolved inflammation, further workup for alternative causes of diarrhea can be continued.