Case 28: Introduction

History of Present Illness (HPI)

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A 56 year-old man with a past medical history of hypertension, hyperlipidemia, and Crohn’s disease presents to the hospital with fatigue and abnormal blood tests.

He reports he has become more fatigued over the past several weeks. He denies fevers, chills, night sweats, nausea, vomiting, shortness of breath, chest pain, or syncope. He notes a slight amount of ankle swelling over the past few weeks that resolves with elevation. He denies new abdominal pain, and reports his bowel movements are always loose but are non-bloody and unchanged for the past year. He is urinating normally and denies hematuria.

His primary care physician checked basic labs and noted an elevation in his Creatinine from baseline 0.7 mg/dL to 1.9 mg/dL and advised him to present to the emergency department for expedited work-up.

The patient’s medications include a combination of infliximab (anti-TNF agent) and azathioprine for his Crohn’s disease, amlodipine, and simvastatin. He has had moderate to severe Crohn’s disease for over twenty years and underwent two bowel resection surgeries in the past. He reports a family history of inflammatory bowel disease but denies any known kidney disease. He denies tobacco, alcohol, or illicit drug use. He works as a car salesman and denies any recent travel.

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