Correct!
5. All of the above

All of the entities listed may produce a granulomatous inflammatory process in the small bowel, particularly the ileum. New-onset Crohn’s disease or ulcerative colitis would be highly unusual in a patient of this age, but nevertheless possible. Basidiobolomycois is an infection caused by the fungus Basidiobolus ranarum, an emerging invasive fungal infection in desert regions of the U.S. Southwest that may mimic malignancy or inflammatory bowel disease and could present in this manner. Sarcoidosis and histoplasmosis are additional considerations as well.

Which of the following represents the next appropriate management step for the evaluation of this patient? (Click on the correct answer to proceed to the nineteenth and final page)

1. Assessment for stool pathogens
2. Inflammatory bowel disease markers
3. Repeat colonoscopy using sterile specimen collection methods
4. Surgical exploration of the abdomen
5. All of the above

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