Diagnosis: Crohn's disease, diagnosed in 2001, initially presenting with small bowel obstruction managed conservatively.1

IBD Phenotype: Crohn's disease, ileocolonic (L3), penetrating behaviour (B3); no perianal disease documented.1

Active Medications:
1. No current IBD therapy1

IBD-Related Surgeries / Hospitalizations:
- 2001: hospitalization for partial small bowel obstruction — at Crohn's disease diagnosis, managed conservatively without upfront surgery.2
- 2022-04 to 2022-05: IBD flare hospitalization (2022-05-03 to 2022-05-06) — admitted with Crohn's flare and right lower quadrant/abdominal wall abscess with apparent enterocutaneous and enterovesicular fistula; treated with IV tazocin with high-dose prednisone planned; positive abscess cultures (Klebsiella pneumoniae, Bacteroides fragilis); discharged home with percutaneous drain in situ; IV iron transfusion for anemia in May 2022.2
- 2022-05-04: IR-guided percutaneous drainage of right lower quadrant/abdominal wall abscess — placement of 10F drainage catheter (abscess 8.5 x 5.1 cm on CT, in communication with the bladder; decreased to 6.9 x 1.8 cm on 2022-05-06); drain kept in situ until the July 2022 surgery.3
- 2022-07: open right hemicolectomy (ileocolic resection) — for enteroenteral and enterocutaneous fistulae in the setting of right lower quadrant abscess and apparent enterocutaneous/enterovesicular fistula; 28 cm of small bowel and 4 cm of colon resected; side-to-side stapled ileocolonic anastomosis; previous drain site and cutaneous fistula tract opened; fistula noted between distal terminal ileum, bladder, and abdominal wall; no ostomy created; pathology consistent with severe Crohn's disease, no dysplasia; no immediate complications, minimal estimated blood loss.4

Extraintestinal / Associated IBD Conditions:
- 2023-2024: anti-TNF-induced (paradoxical) psoriasis — developed on infliximab (started Nov 2022), initially mild pruritic psoriatic rash over ears, upper back, and arm extensors (Nov 2023), became severe and widespread by Jan 2024; required prednisone taper starting at 40 mg (Jan 2024); psoriasis improved significantly after stopping infliximab; limits future anti-TNF therapy options.5
- 2024 to present: eczema related to Skyrizi — ongoing widespread eczematous skin reactions on the body, biopsied and confirmed as eczema by dermatology; managed by Dermatology and Immunology; ongoing as of the Dec 2025 visit.6
- 2012: erythema nodosum — occurred in the setting of subsequent flares of Crohn's disease; no specific date documented.7

Past Medical History:
- 2022: iron deficiency anemia — required IV iron replacement.8
- 2021-09-12: rectal hyperplastic polyp — removed with cold snare on colonoscopy.9
- Mild left-sided diverticulosis — noted on 2026-04-09 colonoscopy.10
- Cholelithiasis — documented on abdominal imaging and prior assessments.11
- Small internal hemorrhoids — noted on anoscopy 2012-05-23.12
- Asthma.13
- Hypothyroidism — mild.4
- Osteoporosis — treated with Prolia every 6 months.4
- Peripheral neuropathy — attributed to a prolonged course of ciprofloxacin/metronidazole.8
- Nephrolithiasis.8
- Migraine.8
- Hypermobility.5
- History of recurrent Staphylococcal skin infections — requiring IV antibiotics.14
- Left rotator cuff tear.15
- 1976, 1983, 1985: three Caesarean sections — prior C-section incisions; the 2022 abdominal abscess/fistula tract was located near the C-section scar.5
- Tonsillectomy — date not reported.16
- Laser treatment for partly detached retina — date not reported.16

Prior IBD Therapies:
- 2026-05-31 to present: No ongoing IBD-directed maintenance therapy documented (8-week Skyrizi washout completed ahead of SIBERITE/SOLACE-IBD study screening; anti-TNF precluded by history of anti-TNF-induced psoriasis; Rinvoq discussed as a future option in Apr 2026 but assessed as unlikely to help her small segment of ileal disease)17
- 2023-Dec/2024-01-21 to 2026-04: Skyrizi (risankizumab) — induction 600 mg IV at weeks 0, 4, 8, then 360 mg SC q8w from week 12; clinical remission documented 2024-05-27, with symptomatic and biomarker remission and excellent clinical and biochemical response at the Dec 2025 assessment; ongoing eczematous reaction related to Skyrizi; secondary non-response documented at the 2026-04-09 colonoscopy (endoscopically active recurrence, Rutgeerts i4, SES-CD 6); discontinued 2026-04 for SIBERITE/SOLACE-IBD study screening with 8-week washout completed 2026-05-31 (some referral letters date the start to Dec 2023, while the treatment initiation confirmation documents 2024-01-21)18
- 2022-12-05 to 2024-01-02: infliximab (Remicade) 300 mg IV at weeks 0, 2, 6, then q8w (started post–right hemicolectomy of Jul 2022 for maintenance of post-operative remission; started Nov 2022); dose escalated to 500 mg IV q6w with an extra 500 mg stat dose on 2023-07-20; doing well per Aug 2023 assessment; developed anti-TNF-induced psoriasis after the summer 2023 dose increase, worsening with each infusion; discontinued 2024-01-02 due to anti-TNF-induced psoriasis (intolerance)5
- 2022-05-03: prednisone 60 mg PO daily started on admission for Crohn's flare, with taper; outcome documented as failure (loss of effect); concurrent ciprofloxacin 500 mg PO BID and metronidazole (Flagyl) 500 mg PO BID for IBD-related right lower quadrant abscess with enterocutaneous/enterovesicular fistula (abscess grew Klebsiella pneumoniae and B. fragilis, sensitive to ciprofloxacin), continued leading up to surgery19
- 2022-04-12 to 2022-05-11: Entyvio (vedolizumab) 300 mg IV (loading doses at weeks 0, 2, 6, then q8w); inadequate response — symptoms worsened despite Entyvio; stopped 2022-05-11 due to fistulizing disease with planned switch to anti-TNF20
- 2022-03-08 to 2022-05-03: Entocort (budesonide) 9 mg PO daily; partial response (seemed to help right lower quadrant pain, which recurred after a couple of weeks); used as bridge to planned Entyvio start; stopped around the May 2022 admission19
- ~2012 to 2022-03: No ongoing IBD-directed maintenance therapy documented (off all IBD-directed therapy; no IBD medications for many years since stopping Pentasa; biologic-naive during this period)21
- ~2001-2002 to ~2012: Pentasa (mesalamine) — used only sporadically; no response details documented; stopped at some point before 201222
- 2001: 5-ASA (agent/dose not specified) and one course of corticosteroids after Crohn's disease diagnosis; no dates, doses, or response details documented; no prior biologics until vedolizumab in 202211

Social History: Ex-smoker, approximately 6 pack-years (1/4 pack per day for 25 years); denies current tobacco or vaping use. Alcohol: rare consumption historically (approximately 2 drinks per month), currently 0 drinks per week. No illicit drug, cannabis/CBD, or IV drug use. Retired manager, active lifestyle. Married, lives with her husband, has 3 children. Independent with ADLs and IADLs, not on disability. Insured (OHIP) with private drug coverage through her spouse's group plan; no documented social barriers to IBD therapy.

Family History: Two children (first-degree relatives) with celiac disease, including a daughter; grandchildren (second-degree relatives) with celiac disease, and a granddaughter may have celiac disease. Children have psoriasis (possible genetic component alongside anti-TNF-induced psoriasis). No family history of Crohn's disease.23

Labs:
- 2026-03-22: fecal calprotectin 886 µg/g.24
- 2025-11-02: Hgb 141 g/L, albumin 46 g/L, CRP <0.5 mg/L.10
- 2025-Oct: Hgb 141 g/L, CRP <0.5 mg/L.25

Endoscopy History:
- 2026-04-09 Colonoscopy: anastomotic nodularity with erythema extending approximately 3 cm into the neoterminal ileum and involving the blind limb, mild narrowing, and 3 ulcers with intervening normal mucosa; mucosa normal beyond 5 cm into the neoterminal ileum; ascending colon and anastomotic area normal; remainder of colon normal aside from mild left-sided diverticulosis; endoscopically active Crohn's recurrence at the anastomosis and neoterminal ileum, Rutgeerts i4, SES-CD 6; asymptomatic.10
- 2024-11-03 Colonoscopy: 3 aphthous ulcers in the neoterminal ileum, Rutgeerts score 1; remainder unremarkable.26
- 2024-10 Colonoscopy: very mild disease activity.27
- 2023-05-28 Colonoscopy: widely patent ileocolonic anastomosis with 4 aphthous ulcers in the distal 10 cm of the neoterminal ileum, consistent with Rutgeerts score 1 / mild endoscopic recurrence; remainder of colon unremarkable.28
- 2021-09-12 Gastroscopy: unremarkable, no esophagitis or Barrett's.9
- 2021-09-12 Colonoscopy: reached the ileocecal valve with benign smooth narrowing likely from prior inflammation; no ulceration or active colitis; terminal ileum appeared normal; 4 mm rectal polyp removed by cold snare.9
- 2021-08 Colonoscopy: normal; however, the ileocecal valve was tight and the scope could not be passed into the terminal ileum.29
- 2012-05-23 Colonoscopy with anoscopy: small internal hemorrhoids on anoscopy; colonoscopy reached the cecum and entered the distal terminal ileum but could not advance further because of a mild stricturing process that was not obviously scarred, inflamed, or ulcerated; tiny cecal ulcers and scattered loss of vascularity on withdrawal, but no significant Crohn's colitis; clinical and endoscopic remission.12

Pathology:
- 2026-04-09 (reported 2026-04-15), neoterminal ileum biopsies: focal active inflammation; no granulomas or dysplasia.10
- 2026-04-09 (reported 2026-04-15), right colon, left colon, and rectum biopsies: no histopathologic abnormality; no granulomas or dysplasia.30
- 2022-07 (specimen collected 2022-08-18, signed 2022-08-25), right hemicolectomy/ileocolic resection specimen: chronic active enteritis with vague granulomatous inflammation, submucosal fibrosis, transmural involvement, and deep perforated ulceration, typical for Crohn's disease; proximal margin within normal limits; distal margin with slightly increased nonspecific chronic inflammation; reactive atypia present, definite dysplasia not identified.31
- 2021-09-12, terminal ileum biopsy: moderate chronic colitis with small numbers of neutrophils, consistent with Crohn's disease; dysplasia not identified.32
- 2021-09-12, stomach biopsy: normal.32
- 2021-09-12, duodenum biopsy: normal; negative for celiac disease (in context of possible celiac disease; patient DQ2 positive but not homozygous, celiac antibodies negative).33
- 2021-09-12, right and left colon biopsies: within normal limits; no active colitis.32
- 2021-09-12, rectal polyp: hyperplastic polyp.9
- 2012-05-23 (reported 2012-06-03), terminal ileum biopsy: mild acute and chronic ileitis; no granuloma, dysplasia, or malignancy.34
- 2012-05-23 (reported 2012-06-03), ileocecal valve biopsy: no diagnostic abnormality.35
- 2012-05-23 (reported 2012-06-03), random colon biopsy: mild chronic inflammatory infiltrate of the lamina propria; no active colitis, granuloma, dysplasia, or malignancy.34

Imaging:
- 2025-11-04 MRI enterography (MR enterography): short segment of mildly thickened neoterminal ileum with progressive enhancement and mesenteric vascular congestion with a few small mesenteric lymph nodes, concerning for active inflammation; no upstream obstruction, fibrostenotic disease, stricture, fistula, sinus tract, abscess, or small bowel dilation; remaining large bowel normal; cholelithiasis.36
- 2022-05-07 CT abdomen/pelvis: anterior abdominal wall abscess significantly decreased after interval percutaneous drainage, measuring approximately 6.9 x 1.8 cm with gas and fluid; dorsal tract toward several small bowel loops decompressed; a diffusely thick-walled small bowel loop remained supportive of Crohn's disease; significant interval improvement.37
- 2022-05-03 CT abdomen/pelvis: interval progression of enterocutaneous fistula with large anterior abdominal wall abscess (5.1 x 8.5 cm) with fluid and gas, communicating with the bladder; persistent active inflammatory bowel disease involving the distal ileum with probable enterovesicular and enteroenteric fistulae; cholelithiasis.15
- 2022-04-21 CT abdomen/pelvis: very long segment of terminal ileal thickening with surrounding inflammatory change, consistent with active Crohn's disease; complex fistula from the ileum to the bladder extending to the right rectus abdominis muscle; multiple enlarged mesenteric lymph nodes; multiple gallstones; no other involved small or large bowel segments.38
- 2021-12-09 MRI abdomen/pelvis: active inflammatory Crohn's disease in the terminal ileum with circumferential wall thickening, mural edema, and mucosal hyperenhancement involving the distal 12 cm; 2 skip lesions, the longest approximately 13 cm; no fistula, abscess, lymphadenopathy, colitis, or proctitis; cholelithiasis.39
- 2001-11-22 CT abdomen/pelvis with contrast: considerable thickening of the terminal ileum with decreased free fluid compared with prior study, consistent with inflammatory bowel disease affecting the distal 20 cm of small bowel.16