You are assessing a 24-year-old woman with medical history significant for Hashimoto’s thyroiditis and Crohn’s disease, which was diagnosed at age 18. She states her disease has involved the terminal ileum and right side of her colon.
Her symptoms were well controlled on Adalimumab for two years, until 2 days ago when she developed abdominal cramping, nausea and several episodes of vomiting containing bilious contents. Her last bowel movement was 4 days ago.
Her last colonoscopy was 18 months ago, where she was noted to have small ulcerations in the terminal ileum and a normal appearing colon.
• Current medications include:
Adalimumab injection every 2 weeks, Levothyroxine 25 mcg and Vitamin D supplement
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