......... waiting for GI Jon to chime in before I get in trouble.
Hepatosplenic T-cell lymphoma has occurred mostly in teenage or young adult males with Crohn?s disease or ulcerative colitis who were taking TNF blockers with azathioprine or mercaptopurine.
22 and surgery?, sounds bad. If he needs surgery, then can he really wait for March to see GI, April to get the auth and infusion arranged, and June before the Remicade captures his Crohns?
You have a diagnosis, a treatment, and a surgeon. You need labs to verify no infection, and the surgeon can poke on the belly to make sure there isn't a fistula ready to pop. Your hospital could infuse 5 mg/kg next week if you can get an emergency auth for continuity of care on Remicade with worsening illness. Probably a call from you would do it. A PPD would be nice if more than a year. Do you have histo there? HepB testing should also have been done if he's been on Remicade.
In a pinch, rheumatologists have samples of injectable TNFs in their office. We don't want to play GI, but I infuse 2-4 GI patients a week. Amazing what they can do for Crohns n UC. A local heme-onc might be willing to get involved
...that is if Jon doesn't get riled
