Title :

Severe steroid refractory ulcerative colitis patient that is biologic and immune modulator naïve

Category :

Adult, Steroid refractory UC

Drug :

Anti-TNF therapy, Azathioprine, Corticosteroids, Cyclosporine, Prednisone

IBD Horizon’s Annual Seattle Symposium Fall 2016

case-2-image-art

  • 25 year old female diagnosed 3 years ago with moderate to severe pan ulcerative colitis. Initially started on prednisone with moderate response. Also started on 4.8 gm/day of mesalamine. Despite compliance with mesalamine, has required multiple courses of high dose prednisone since diagnosis
  • Patient presents with worsening symptoms despite increasing outpatient prednisone to 60 mg per day
  • Due to severe anemia, weight loss and intolerable symptoms, admitted to the hospital and started on 60mg IV Methylorednisolone after undergoing Flexible sigmoidoscopy which shows severe colitis beyond extent of exam and having ruled out evidence of C difficile or CMV
  • She is on day 2 of IV steroids without improvement

Conclusions: Patient should be considered for anti-TNF therapy or calcineurin inhibitor days 3-5 from starting IV steroids if no response. A surgical consultation should be done in case medical therapy fails. Strong consideration should be given to patient’s nutritional status and albumin level since these may impact choice of dose and frequency.

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