Abstract
An 80-year-old patient with rheumatoid arthritis treated with methotrexate and plaquenil was admitted for chronic diarrhea and abdominal pain. Considerable ambulatory workup (including multiple blood, stool and urine tests and cultures; chest and abdominal X-rays and ultrasound; upper GIT barium series and two colonoscopies with biopsies) and one prior hospital admission were unhelpful. Diverticulosis (known in the past) was noted as a side finding. She was forced to stop driving her car and became completely bedridden. After several empiric treatment failures, she was admitted reporting 12 weeks of frequent (>10/day), macroscopically unremarkable diarrhea associated with tenesmus; constant lower abdominal pain with occasional colic; anorexia and marked weight loss, but neither fever nor sweats. Examination revealed cachexia (45 Kg, previously 56), with normal vital signs and bowel sounds. The lower abdomen was tender to deep palpation (Left>Right) with rebound tenderness but no rigidity, mass or other abnormality. Hb was 11.3 g/dl; WBC 10.2 × 103/ul; platelets 545 × 109/l; …
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