Diagnosis: Crohn's disease (terminal ileal/ileocolic), diagnosed in 2018 when she presented with small bowel obstruction.1

IBD Phenotype: Montreal L1 (terminal ileal/ileocecal) location; B2 (fibrostenotic/stricturing) behaviour; no perianal disease documented.2

Active Medications:
1. Risankizumab (Skyrizi) 360 mg SC every 8 weeks; started 2025-08-25 (600 mg IV loading doses Aug 25, Sep 22, and Oct 20, 2025, then home subcutaneous injections from week 12)1

IBD-Related Surgeries / Hospitalizations:
- 2018-08: Bowel obstruction — initial presentation of Crohn's disease.2
- 2024-03-02: Emergency visit for IBD complication — acute abdominal pain in known Crohn's disease on Remicade, with nausea and diarrhea; abdomen soft and non-tender; discharged home.3
- 2024-11: Laparoscopic ileocolic resection — resection of terminal ileum (22.0 cm) with attached mesentery, ileocecal valve, appendix (6.5 cm) and colon (9.3 cm); GIA 80 stapled side-to-side isoperistaltic anastomosis; uncomplicated postoperative course; pathology consistent with Crohn's disease.4

Extraintestinal / Associated IBD Conditions:
- 2024-02: TNF inhibitor-induced psoriasis — rash developed one week after the first Renflexis (infliximab) dose (onset 2023-12-21), affecting scalp, groin, knees and arms; treated with topical cortisone 0.1% then Zoryve cream qHS; stable/improved on topical therapy.1

Past Medical History:
- 2016: Cholelithiasis and choledocholithiasis — multiple gallstones with a 0.3 cm stone in the distal common bile duct; treated with laparoscopic cholecystectomy September 2016.5
- Anxiety.2

Prior IBD Therapies:
- 2018-10 to 2018-11: prednisone 5 mg PO; short course completed as of Nov 14 per medication history note.6
- 2019-03 to 2021-03: ustekinumab (Stelara) — induction 260 mg IV (2019-04-25), then 90 mg SC every 8 weeks from week 16; interval optimized to every 4 weeks; ongoing disease activity clinically and on imaging despite optimization; secondary loss of response — discontinued March 2021.2
- 2021-04-21 to 2023-09: infliximab (Remicade) — induction 300 mg IV at weeks 0, 2, 6, then 300 mg IV q8w; dose increased to 500 mg IV q6w by 2021-11-18; infusion reaction during first infusion (lip tingling, BP drop 101/69 to 88/59, managed with slowed rate, diphenhydramine 25 mg IV and fluids, infusion completed); TNF-inhibitor-induced psoriasis-like rash managed with topicals; switched to infliximab biosimilar Renflexis (non-medical switch) in December 2023.2
- 2023-12-14 to 2025-07-13: infliximab biosimilar Renflexis 500 mg IV q6w (non-medical switch from Remicade); psoriasis-like rash one week after first infusion (2023-12-21), treated with topical cortisone 0.1%; infliximab continued perioperatively and post-resection; endoscopic recurrence (Rutgeerts 2, numerous aphthous ulcers in the neoterminal ileum) approximately 9 months post-resection despite infliximab therapy; last infusion 2025-07-13, then switched across class to risankizumab.7
- 2025-08-25 to present: risankizumab (Skyrizi) — induction 600 mg IV at weeks 0, 4, 8 (Aug 25, Sep 22, Oct 20, 2025; no reactions), then 360 mg SC every 8 weeks from week 12; EAP funding approval for Crohn's disease; ongoing per prescription renewal signed Aug 26, 2026.8

Social History: Non-smoker; drinks 1-2 alcoholic drinks per average week (wine and beer); no cannabis or recreational/illicit drug use. Formerly worked in child care; currently completing online schooling in human resources. Insurance: private/ODSP.1

Family History: Paternal uncle with Crohn's disease; grandmother with stomach cancer. Extended family history also reports colon cancer, gallstones, cancer, and diabetes (relationships not specified).1

Labs:
- 2026-06-30: Fecal calprotectin 429 µg/g (persistently elevated; values consistent with active inflammation).9

Endoscopy History:
- 2025-08-17 Colonoscopy: Neoterminal ileum intubated about 20 cm; distal 10 cm showed countless aphthous ulcers, Rutgeerts score 2; no erythema, deep ulceration, or strictures; anastomosis widely patent; remainder of colon unremarkable.1
- 2024-09-15 Colonoscopy: Ileocecal valve stenotic with no active ulceration, scope unable to pass across the neoterminal ileum; colon unremarkable with no active Crohn's disease; rectal retroflexion unremarkable.2
- 2023-06-11 Colonoscopy: Normal to the terminal ileum; one small descending colon polyp removed.10
- 2018-11-08 Colonoscopy: Possible mild Crohn's ileitis.11
- 2018-10 Colonoscopy: Narrowing at the level of the terminal ileum; remainder of colon unremarkable.12

Pathology:
- 2024-11-17, ileocolic resection specimen (ileum 22.0 cm, colon 9.3 cm): Chronic active ileocolitis with ulceration, fibrosis and transmural chronic inflammation compatible with Crohn's disease; no granulomas or dysplasia; margins negative for dysplasia or malignancy; appendix within normal limits.13
- 2023-06-11, descending colon polypectomy: Nonspecific regenerative change.10
- 2018-11-08, terminal ileum, colon and rectal biopsies: Terminal ileum — focal mixed inflammation of the lamina propria with a solitary focus of cryptitis, negative for crypt abscess formation, granulomas, dysplasia or neoplasia; colon and rectum — normal, negative for active inflammation, granulomas, dysplasia or neoplasia; no evidence of microscopic colitis.14

Imaging:
- 2024-05-28 MR enterography: Relatively similar to the September 2022 study; acute on chronic IBD with luminal narrowing and mild proximal distention; suspicious for an element of associated obstruction.10
- 2022-10-10 MRI: Circumferential bowel wall thickening with mucosal hyperenhancement at the terminal/distal ileum over 15-20 cm; small bowel dilated up to 5.5 cm suggesting luminal stricturing; no obstruction; suggestive of fibrostenotic disease.10
- 2021-03-14 MRI: Abnormal distal ileal small bowel loops now 16 cm (previously 10 cm), extending to the ileocecal valve, with mild-moderate luminal narrowing; mild acute on moderate chronic small bowel inflammation; no obstruction.10
- 2019-09 MRI: 10 cm of terminal ileum extending to the ileocecal valve with mild upstream dilation; additional 2 cm segment of fibrostenotic changes in the mid ileum with minimal upstream dilation.10
- 2019-02 MRI: 15-20 cm length of terminal ileal disease, with dilation of the small bowel proximally up to 5 cm.10
- 2016-09-16 Abdominal ultrasound: Multiple gallstones with a non-thickened wall and no pericholecystic fluid; 0.3 cm calculus in the distal common bile duct without biliary dilation; solid organs unremarkable.15