[Clinical decision making in family practice. A patient with abdominal pain and chills].
An 82-year-old man was admitted because of abdominal pain and a shaking chill. His medical history revealed ileocecal resection because of ileitis associated with a Yersinia infection 3 years before admission. One year later he was readmitted because of bowel obstruction due to recurrent ileitis. He was treated with trimethoprim-sulfamethoxazole for two weeks because of positive serological tests for Yersinia and made a full recovery except for chronic diarrhoea. On the current admission, stool cultures yielded Campylobacter upsaliensis. Further analysis showed severe non-specific ulcerative ileitis without colitis. A diagnosis of Crohn's disease was made. The patient was treated with prednisone and mesalazine and made a full recovery. The chronic diarrhoea disappeared. The course was complicated by a cerebro-vascular thrombosis and severe thrombocytosis due to polycythaemia vera. Treatment with hydroxyurea was effective in lowering the thrombocyte count.
Schippers
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EF
Leids Universitair Medisch Centrum, afd. Algemene Interne Geneeskunde, Leiden.
de Meijer
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PH
Meinders
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AE
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D007079:Ileitis / Q000175:diagnosis; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D016896:Treatment Outcome
D019804:Mesalamine; D011241:Prednisone; D006918:Hydroxyurea