Terminal Ileitis!

Dr. Tyler Wells presented a great case at noon report making us all scratch our heads and realize the importance of recognizing anchoring bias.

A 26 year old man presented with 4 weeks of RLQ pain, nonbloody diarrhea, fever and weight loss. He had no history of immunosuppression or clear exposures. He had a CT scan showing mass-like wall thickening of the terminal ileum concerning for cancer. This lead to to an extensive work up including a colonoscopy with biopsy showing inflammation but no malignancy. He had a repeat CT weeks later which showed complete resolution of inflammation. His diarrhea had also resolved. In reviewing the history, his course fit best with Yersinia ileitis (though he never had stool studies to confirm).

This led to a vibrant discussion about the differential for terminal ileitis. Our beloved Program Director, Sima, provided us with her short differential for ileitis. Also see this article (Facing Terminal Ileitis: Going Beyond Crohn's Disease) for a more extensive discussion on the differential.