Fever of Unknown Origin in an Immunosuppressed Patient with Crohn's Disease: An Unusual Cause

Chronic immunosuppressive exposure, including conventional and biologic agents have been shown to increase the risk of infection especially in individuals with inflammatory bowel disease (IBD) receiving combination therapies. Practitioners should be cognizant of these risks in order to provide best available care. We illustrate a case of an immuno-suppressed patient with Crohn's disease who did not have an identifiable organic cause for fever of unknown origin (FUO). Our patient presented with high fevers, positive blood cultures, and a variety of normal imaging studies. An unexpected diagnosis of Munchausen syndrome was brought to light after an extensive evaluation proved to be unrevealing. This case underscores the importance of formulating a broad differential diagnosis in IBD patients who develop fevers while on chronic immuno-suppressants.