A 36-Year-Old Patient With Crohn Disease and Bilateral Pleural Effusions

A 36-year-old man with severe Crohn disease complicated by urethral strictures and enterocutaneous and enterovesicular fistulas presented for several weeks of poor appetite, weight loss, failure to thrive, and newly worsening altered mentation. Further history revealed he chronically did not urinate through his urethra, but rather "leaked" through multiple enterocutaneous fistulas in his abdomen and perineum. Medications included ustekinumab (anti-IL12/IL23 monoclonal antibody) for Crohn disease, methadone, and hydrocodone. He had had multiple surgeries because of fistulas related to his Crohn disease, which included subtotal colectomy with ileostomy creation, proctectomy, and ischiorectal flap creation. He drank 10-15 ounces of liquor per week, smoked 10 cigarettes daily, and smoked marijuana weekly.