Andrea Alvarez, MBS, DO, Edwin Makarevich, DO, Ronen Arai, MD Broward Health, Fort Lauderdale, FL
Introduction: About 25% of patients who suffer from inflammatory disease of ulcerative colitis are at risk for developing acute severe ulcerative colitis (ASUC). The definition of ASUC is the passage of >6 loose bloody stools per day with evidence of systemic toxicity. Over the past decade, the management of this disease has evolved significantly with the availability of various safe and effective medical therapies. One of the notions we have learned with this disease, which seen in our case, is that prompt initiation of medical therapy is key in better outcomes.
Case Description/Methods: A 51-year-old female with history of proctosigmoiditis began to have a flare. Following her initial diagnosis, the patient did well with rectal and oral mesalamine, however after about 1 year after her diagnosis, she started to experience symptoms. After about 1 week of oral Prednisone 40mg, she was admitted to an outside hospital. During this hospitalization she did not have much improvement, and there were also concerns of steroid-induced pancreatitis. The patient was found to have positive QuantiFERON, and was started on Rifampin and Isoniazid by an infectious disease (ID) physician. She presented to our institution a few days after her discharge with abdominal pain, 6-7 loose stools, rectal bleeding and nausea. She received IV methylprednisolone 30mg q12 despite the prior concern of pancreatitis, and by 2nd day improved to only 1 bowel movement and no bleeding. While the plan was to start her on a biologic therapy, given her positive QuantiFERON this needed to be put on hold until completion of anti-TB therapy, therefore she was discharged given her clinical improvement and was instructed to follow up outpatient with GI and ID. The patient was readmitted about 10 days later making this her 3rd hospitalization within a month, with worsening abdominal pain, diarrhea and rectal bleeding. She was acutely ill-appearing, febrile, and abnormal laboratory findings. She was started on IV methylprednisolone 30mg Q6 for a few days, which stabilized her in the interim, and eventually she received high dose Infliximab x 2 with the consensus of the multidisciplinary team.
Discussion: This case report describes the effectiveness of aggressive biologic such as infliximab in ASUC after failure of IV steroids despite her latent TB. Early recognition of ACUS enables the physician to construct an appropriate treatment plan for the individual patient given their unique presentation including early surgical consult if colectomy is needed.
Disclosures:
Andrea Alvarez indicated no relevant financial relationships.
Edwin Makarevich indicated no relevant financial relationships.
Ronen Arai indicated no relevant financial relationships.
Andrea Alvarez, MBS, DO, Edwin Makarevich, DO, Ronen Arai, MD. P2248 - A Case of Acute Severe Ulcerative Colitis in a Hospitalized Patient With a Positive QuantiFERON, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.