Extract

Learning Objectives

After completing this journal-based activity, physicians should be better able to:

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Presentation

Dr. Abhishek Gulati, 2014 to 2015: First Year Fellow in Gastroenterology at Allegheny Health Network

This is a 42-year-old male who was diagnosed with ulcerative colitis in 1995 after presenting with lower abdominal pain, cramping, urgency, and bloody diarrhea. His ulcerative colitis was treated with sulfasalazine and intermittent courses of high dose prednisone for many years. Small bowel follow through was normal. In 2008, he was started on infliximab and did well for 3 years, but stopped on his own and was lost to follow-up. In 2012, he returned with bloody diarrhea, and a colonoscopy was performed that demonstrated active left-sided ulcerative colitis. He was started on adalimumab but, due to lack of response, it was recommended that he undergo a colectomy.

In December, 2014, he presented to our center for a second opinion. For the past 10 months, he has been receiving 40 mg of adalimumab each week and remains on 25 mg of prednisone and mesalamine. The patient's medical and surgical histories are otherwise noncontributory. He is a landscaper who lives with his family at home. He denies alcohol consumption, cigarette smoking, or recreational drug use.

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