Stephen L. Wolman

Stephen L. Wolman, MDAssistant Professor, Depts. of Medicine and NutritionUniversity of Toronto

Patient History

M.A. is a 16 year-old female who first developed problems in February of 1993. She initially presented with bloody diarrhea and was referred by her family doctor to a gastroenterologist. A colonoscopy with biopsies was performed and Crohn's disease was diagnosed. She was started on steroids (prednisone) and 5-ASA (Asacol) and was well until September 1993 when she developed abdominal pain and bloody diarrhea. She was started on steroid (Betnesol) and 5-ASA (Salofalk) enemas on alternating days and did well enough to go on a camping trip at the end of September. However, in early October she was again having abdominal pain, five to ten bowel movements per day and multiple bowel movements in the night, which were described as watery with traces of bright red blood and mucus. She was again seen by a gastroenterologist who started her on a steroid (prednisone), and azathioprine. She subsequently developed nausea, vomiting and intermittent, crampy lower left quadrant pain with associated fever and chills. Her bowel motions decreased in volume, but were still watery and bloody. Azathioprine was discontinued after only two days. At this point she was being treated with daily steroids (prednisone) and 5-ASA (Asacol), with enemas on alternating days. She was transferred to another hospital for a second opinion.

Physical Examination