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Please complete the case study questions in the file attached below
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Clinical Case Study No. 2
2024
Name:
Student Number:
Date:
PHU33111 – Immunology Clinical Case Study
AB is a 35 year old male who was has had a year-long history of daily bloody diarrhoeal episodes with
abdominal cramping. Biopsies of his colon have shown Crohn’s disease. He has a past medical history
of recurrent urine infections and as a child was diagnosed with tuberculous adenitis. There is a strong
family history of cancer, including colon cancer, breast cancer and lymphoma, as well as diabetes
mellitus. He is not currently on any medications. He works in the construction and building
refurbishment business doing manual labour. He has no children but would like to plan a family at
some point soon with his partner.
His Gastroenterologist is starting treatment with steroids and 5-ASA. You are the pharmacist
supporting the Gastroenterology Multi-Disciplinary Team and need to provide pharmacological
support to the patient and the team during treatment.
Questions (Marks: 100):
1. Describe the immune pathology of Inflammatory Bowel Disease/Crohn’s Disease. List the
type of cells, cytokines/chemokines and other mediators involved as well as the resultant
pathology. (Marks: 20)
2. What is the mechanism of action of steroids in the treatment of IBD? (Marks: 10)
3. What is the mechanism of action of 5-ASA in the treatment of IBD? (Marks: 10)
After 4 weeks of treatment, AB’s diarrhoea and cramping has worsened. He now also has anaemia.
His Gastroenterologist stops the 5-ASA, continues the steroid at a higher dose and starts Ciclosporin.
4. For Ciclosporin, what is the (Marks: 10):
a. Drug class
b. Mechanism of action
5. What blood tests and/or monitoring and supportive medications should you consider for
this patient considering his background history, current drug therapies and new anaemia?
(Marks: 10)
Clinical course:
Unfortunately, AB is not responding to therapy after another 4 weeks. A repeat colonoscopy shows
worsening IBD with new perianal lesions and fissures being formed. Ciclosporin is stopped, steroids
are continued, and Infliximab is started.
6. With regards to the steroid treatment at this point in his therapy (Marks: 10):
a. What side effects would you expect?
Clinical Case Study No. 2
2024
b. What supportive medications should he already be on or should you advise the
team to start now?
7. With regards to Infliximab (Marks: 10):
a. What type of drug/drug class is it?
b. What is the mechanism of action?
8. What tests should be performed prior to the start of Infliximab in this patient? (Marks: 10)
Clinical course:
After 2 infusions of Infliximab, the patient starts to improve and therapy is continued. After 6 months
of therapy, the IBD is in remission. However, a new lump appears in his groin.
9. What side effects and risks of Infliximab treatment would concern you when you hear about
the appearance of this lump? (Marks: 10)
Total Marks: 100
When you provide answers, we will allow for maximum 1,500 words for the entire case study (do not
aim for this much).
Please use bullet point for answers.
Deadline:
Thursday, 4th April 2024 at 3pm
This is a hard deadline – any late submissions will be capped at the pass mark.
Please use bullet point for answers.
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