A 24-Year-Old Crohn's Patient Starting Immunosuppressive Therapy
A 24-Year-Old Crohn's Patient Starting Immunosuppressive Therapy
A 24-year-old preschool teacher with a 3-year history of Crohn's disease (CD) presents to your office for a second opinion regarding the management of 4-week history of worsening abdominal pain and diarrhea. She has lost 8 pounds during this time. On physical examination, she has tenderness in the right lower quadrant. Colonoscopy is performed and reveals progression of her disease, with evidence of severe terminal ileitis and moderate extensive colitis. She notes that she has been compliant with her mesalamine regimen. Her father also has CD, maintained on 6-mercaptopurine (6-MP), and recently developed a severe episode of herpes zoster. After a long discussion, the decision is made to initiate therapy with an anti–tumor necrosis factor (anti-TNF) agent. She is concerned about infections and wants to know what she can do to minimize her risk.
Clinical Scenario
A 24-year-old preschool teacher with a 3-year history of Crohn's disease (CD) presents to your office for a second opinion regarding the management of 4-week history of worsening abdominal pain and diarrhea. She has lost 8 pounds during this time. On physical examination, she has tenderness in the right lower quadrant. Colonoscopy is performed and reveals progression of her disease, with evidence of severe terminal ileitis and moderate extensive colitis. She notes that she has been compliant with her mesalamine regimen. Her father also has CD, maintained on 6-mercaptopurine (6-MP), and recently developed a severe episode of herpes zoster. After a long discussion, the decision is made to initiate therapy with an anti–tumor necrosis factor (anti-TNF) agent. She is concerned about infections and wants to know what she can do to minimize her risk.