Beneath

A 42 year old man presents with numbness and a tingling sensation in both lower limbs, associated with generalised weakness and fatigability for 3 months.

He also experienced occasional malodorous, bulky stools and lost 8 kg of weight during the preceding year. There was no history of alcohol abuse, rectal bleeding, or joint pains.

His full blood count shows a Hb of 8.7 g/dL and MCV of 112 fL. A blood film shows a megaloblastic anemia with hypersegmented neutrophils.

Select Relevant Investigations
Serum B12 + Folate

Performed

Serum Vitamin B12: 150 pg/ml (200-900)
Serum Folate: 5 ng/ml (5-16)
Stool full report

Performed

No amoeba, ova or cysts identified
No pus cells or erythrocytes
Bacterial and protozoal cultures: negative
Fecal fat analysis: 7g/24h (2-6)
Lower GI endoscopy & biopsy

Performed

There is mucosal inflammation with friability and granularity from the ileum to ascending colon. There are multiple, deep serpiginous ulcerations located transversely and longitudinally. The biopsies are suggestive of Crohn’s disease.
Serum Albumin

Performed

30 g/L (35-55)

Select Relevant Management
Budesonide
NSAIDS
Vitamin B12
Surgical Resection