Iron deficiency anemia (IDA) is one of the most common extraintestinal manifestations of inflammatory bowel disorder (IBD), occurring in roughly one-third of patients, and exacting a significant toll on quality of life and associated healthcare costs. Despite its frequency, it is often overlooked in clinical settings.
To shed light on the often-challenging management of this common condition, MPR presented the case of a hypothetical patient to Tauseef Ali, MD, Clinical Assistant Professor of Medicine at the University of Oklahoma in the section of Digestive Disease and Nutrition and Chief of Gastroenterology Section at Saint Anthony Hospital. Dr. Ali is also the Director of the Inflammatory Bowel Disease Program and Research Center.
Mr. W, a 28-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.
History of presenting complaint
Mr. W’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.
- Ciprofloxacin (500mg PO BID)
- Metronidazole (500mg PO BID)
- Omeprazole (20mg PO daily)
- Prednisone 40mg PO daily
- Adalimumab 40mg SC every other week