Poorly Responsive Ulcerative Colitis in the Hospital

A 20-year-old woman with a history of UC is referred for symptoms of frequent bloody stools, tenesmus, and the inability to taper off of corticosteroids. She was initially diagnosed with left-sided UC at the age of 8 and had an average of 1 moderate flare per year that responded to an oral steroid taper. She had a normal terminal ileum on previous colonoscopy and a normal small bowel follow-through. During the past 2 years, her disease has become refractory to medical therapies. During this time period, she has been on multiple medications including oral mesalamine, topical rectal corticosteroid and mesalamine preparations, and oral corticosteroids (10–60 mg prednisone). Infliximab was initiated 2 years prior at 5 mg/kg and titrated to 10 mg/kg during the past 18 months. Her last dose of infliximab was 4 months before this evaluation, when it was discontinued as a result of lack of response.

Abbreviations used in this paper: AZA, azathioprine, ESR, erythrocyte sedimentation rate, IPAA, ileal pouch–anal anastomosis, 6-MP, 6-mercaptopurine, TNF, tumor necrosis factor