Treating a Common Extraintestinal Manifestation of Inflammatory Bowel Disease

Mr. C, a 30-year-old male with Crohn’s disease, presented to his clinician with symptoms of fatigue, lethargy, headaches, pallor, hair loss, irritability, and weakness. He states that these symptoms are significantly interfering with his productivity at work and with his family life at home.

Mr. C’s IBD was stable until 6 months ago, when he experienced an exacerbation and began a course of steroids with combination antibiotic therapy with ciprofloxacin and metronidazole. Shortly after initiation of this therapy, he began feeling fatigued, and in the following weeks, he developed hair loss, irritability, and increasingly frequent headaches. His clinician initiated treatment with oral iron supplementation but his symptoms continued to worsen.

Current medications	Mr. C’s laboratory findings
Ciprofloxacin 500mg PO BID Metronidazole 500mg PO BID Omeprazole 20mg PO daily Prednisone 40mg PO daily Adalimumab 40mg SC every other week	Hemoglobin 10.3g/dL Ferritin 40ng/mL C-reactive protein (CRP) 8mg/dL

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