A 27-year-old White woman presents to her primary care physician with reports of fatigue, low-grade fever, prolonged intermittent diarrhea preceded by an urgency to defecate, and steady right lower quadrant pain before defecation, which is somewhat relieved afterward for short periods of time. These symptoms have persisted for nearly 3 months. She is also complaining of arthralgia in her arms, legs, and hips and reports a 15-lb unintentional weight loss over the past 2 months.

Physical exam reveals diffuse abdominal tenderness, low-grade fever of 100.5 °F, presence of simple episcleritis in the left eye, as well as aphthous ulcers on the tongue. The patient appears pale. She is 5 ft 5 in and weighs 110 lb (body mass index is 18.3). Perianal and rectal exam shows inflammation from frequent and prolonged urgent defecation, but nothing remarkable otherwise. Laboratory tests reveal that she is anemic and has multiple micronutrient deficiencies including B12, folic acid, calcium, and magnesium as well as cholestatic alteration of her liver function tests. Platelet count, C-reactive protein and erythrocyte sedimentation rate are all elevated. Stool test shows presence of leukocytes and traces of blood.