Raising the Barr: An Unexpected Lesion at Ileal–Cecal Resection

• Published in: Digestive diseases and sciences Vol. 64; no. 2; pp. 353 - 357
• Main Authors: Mitsialis, V., Wu, Y., Gewurz, B., Bleday, R., Doyle, L. A., Winter, R. W., Hamilton, M. J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2019; Springer; Springer Nature B.V
• Subjects: Adalimumab; B cells; Biochemistry; Cecum - pathology; Cecum - surgery; Colectomy; Colon - pathology; Colon - surgery; Colonic Diseases - diagnosis; Colonic Diseases - pathology; Crohn Disease - complications; Crohn Disease - surgery; Crohns disease; Digestive System Surgical Procedures; Epstein-Barr Virus Infections - diagnosis; Epstein-Barr Virus Infections - pathology; Gastroenterology; Gastrointestinal diseases; Hepatology; Herpesvirus 4, Human; Humans; Ileal Diseases - diagnosis; Ileal Diseases - pathology; Ileum - pathology; Ileum - surgery; Lymphoproliferative Disorders - diagnosis; Lymphoproliferative Disorders - pathology; Male; Medical diagnosis; Medicine; Medicine & Public Health; Monoclonal antibodies; Multicenter Seminars: IBD (MUSE: IBD); Oncology; Reed-Sternberg Cells - pathology; Small intestine; Surgery; Transplant Surgery; Young Adult
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-018-5410-z

A 24-year-old man with stricturing, ileocolonic Crohn’s disease with recent partial small bowel obstruction (SBO) due to terminal ileal stenosis, was evaluated 1 day prior to previously scheduled elective ileocecal resection with complaints of fevers, myalgias, and fatigue. His Crohn’s diagnosis occurred at age 13 (2006) when he was frst evaluated with complaints of diarrhea and weight loss for the prior month. The initial diagnostic colonoscopy demonstrated infammatory changes characterized by superfcial and deep ulcerations with luminal narrowing in the terminal ileum and ascending colon. Initiation of infiximab in 2007 led to clinical remission until 2011 when response to the treatments waned. A switch to certolizumab in 2011 recaptured clinical remission until 2017 when he began to experience breakthrough symptoms. He was ultimately switched to adalimumab in 2017, which required titration from every other week to every 10-day dosing in order to achieve clinical response.