A 38 Years old patient was suffering from Crohn's disease for over 26 years
Stricturing and penetration of small & large bowel were performed. He was also diagnosed with the perianal disease(Complex fistula)
So far conservatively the disease has been managed.
TNF Agents - Developed Serum Sickness-? Antibodies to anti-TNF Agents
Azathioprine -> Anemia
Responded to vendolizumab initially -> Post Covid exacerbation of symptoms - not responding to vendolizumab + Steroid
Endoscopy: not able to cross sigmoid stricture (2 Years)
MRI Pelvis 01.06.21
Complex low rectal fistula with translevator course and significant inflammatory changes
Small intersphincteric abscess
Sigmoidoscopy 01.06.21 - Multiple deep irregular ulcers and polypoidal lesions(? Pseudopolyps) with friable mucosa causing luminal narrowing. Scope could not be negotiated beyond.
Bx - Moderately active inflammation with mucoid lymphoid hyperplasia in a know case of Crohn's disease
March 2020
July 2020
June 2020
At Present, Since 15 Days:
Watery stools- 15/20 days - Small volume- no blood/ mucus
Bloating
Weight loss 8Kg in 15 days
H/o repeated admissions for similar complaints for 3 months (Vedolizumab restated post covid)
22.07.21
Hb - 11.1
TLC- 12000
Plat 3.4 lakhs
Alb - 4.1
Next Option??
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