Skill Checkup: A 28-Year-Old Man With Diarrhea, Nausea, Vomiting, and Abdominal Cramping

Charles Bernstein, MD


February 01, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 28-year-old man presents to an urgent care center in Toronto with diarrhea, nausea, and vomiting. He describes abdominal cramping as well. His height is 5 ft 9 in and weight is 170 lb (BMI, 24.1). The patient was diagnosed with Crohn disease as a teenager and was responsive to thiopurine and methotrexate for years. He also has a history of tobacco use but comments that he is only a "social smoker." After a recent flare 9 weeks ago, the patient began an anti–tumor necrosis factor (TNF) regimen. Body temperature is 100.1 °F and hemoglobin level is 13.1 g/dL. Colonoscopy shows ileitis.


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