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 his primary care physician with fatigue over the past several weeks and is referred to the hospital for abnormal blood tests.

He does not have 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 tells you that his bowel movements are always loose but are non-bloody and unchanged for the past year. He is urinating normally and denies hematuria.

His creatinine has increased from a baseline 0.7 mg/dL last year to 1.9 mg/dL.

The patient’s medications include a combination of infliximab (monoclonal anti-TNFα antibody) 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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