Case Submitted by Kendall Beck, MD
A 65 yo man presents to the gastroenterology clinic with increased stool frequency, abdominal cramping, tenesmus, and passing blood per rectum. He has experienced these symptoms intermittently for the past 5 years, but symptoms would typically resolve after two weeks. He has taken several courses of antibiotics for presumed infectious colitis during these episodes.
Over the past 4 weeks, symptoms have worsened in severity. He reports passage of 5 stools daily which are soft but formed, with blood and mucus, with associated abdominal and rectal pain. On review of systems, he reports weight loss of 35 lbs over the past month despite a good appetite, as well as malaise, weakness, and feeling warm. He denies fever, nausea, vomiting, night sweats, rash, joint pain, oral ulcers, eye pain or redness, or depressive symptoms. He also denies dyspnea, chest pain, lower extremity swelling.
He has a past medical history of heart failure with preserved ejection fraction, chronic obstructive pulmonary disease, basal cell carcinoma, H. pylori infection, and tuberculosis in a lymph node 25 years ago, resected, and status post direct observed therapy. He is a former smoker and denies alcohol or drug use. He has no family history of IBD or GI malignancy
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