16N-0653 was managed for many years with anti-inflammatory agents to treat her “Crohn’s disease” but she was found to have leukocyte adhesion molecule deficiency caused by ITGB2:NM_000211:exon13:c.1756C>T:p.R586 W resulting in a drastically different management. The gene discussed is ITGB2; the disease is hyperinsulinemic hypoglycemia, familial, 4.