no family history Inflammatory Bowel Disease
father from Founder Effect Region (Lac St Jean from Charlevoix, Quebec) with European ancestry (Northern France)
mother from English New Brunswick with Northern European ancestry (mostly Irish with some English)
perinatal factors
born in Toronto
upwardly mobile middle class
mother was 30 and 37 years old
vaginal deliveries
perinatal intravenous antibiotics
breastfed for 15 months
small supplementation with formula
non-smoking household
early childhood
raised in Toronto
summers in Lac St Jean lakeside near farms with dairy cattle
ear and throat infections and antibiotic use
pediatric on-set with sub-clinical symptoms from 2 yrs for dd and 10 yrs for ds
appears to be stenotic CD-subtype
also present with mild pervasive-not-patchy involvement of the colon
perianal disease with tags
HLA-B27 negative
ANCA positive
steroid refractory
anti-TNF therapy refractory
intolerant to IFX and ALA: infections (ears, nose, throat & skin), psoriasis, flu-like symptoms, fibromyalgia-like symptoms
secondary nonresponder: on ALA worsened small bowel disease requiring resection and then developed colitis on maintenance
ileocecal resection and strictureplasty of the ileum
respond to Cipro-Flagyl combo
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