Diarrheic stools with fresh blood and fever
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Bhupinder S. Anand, MD, Professor, Department of Medicine, Baylor College of Medicine, Houston, TX

Bhupinder S. Anand, MD, has disclosed no relevant financial relationships

Question 1 of 3

A 12-year-old boy presents with diarrheic stools with fresh blood, abdominal pain, and fever. He has lost 10 lbs of his body weight in the last month and appears malnourished, although he reports no dietary constraints. Clinical examination on admission shows pale skin, diminished cutaneous turgor, and diffuse abdominal tenderness at palpation.

Laboratory tests show elevated inflammatory biomarkers: erythrocyte sedimentation rate 41 mm/h, and C-reactive protein 15.73 mg/L. Complete blood count reveals leukocytosis (40/mm3) with neutrophilia (290/mm3), thrombocytosis (platelets 630,000/mm3), and anemia (hemoglobin 9 g/L). The stool culture and Clostridioides difficile infection examination are negative. Abdominal ultrasound reveals bloating. Ileocolonoscopy shows fistulas, abscesses, fibrotic strictures, ulcerations (with normal mucosa in between), and a hematoma at the level of the rectum.

What is the diagnosis in this patient?

Ulcerative colitis

Celiac disease

Irritable bowel syndrome

Crohn disease

This quiz is not accredited for CME.

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