[Severe acute colitis: two fatal cases in Dakar]

Area of Science:

• Gastroenterology
• Internal Medicine
• Public Health

Background:

• Inflammatory bowel disease (IBD), particularly ulcerative colitis (UC), can lead to severe acute colitis (SAC), a life-threatening condition.
• IBD is historically considered uncommon in sub-Saharan Africa, with limited data on SAC prevalence and management in this region.

Observation:

• Two fatal cases of SAC in Senegalese patients with UC are presented, occurring in Dakar.
• Both patients presented with chronic dysenteric syndrome; initial management with antibiotics for suspected infectious colitis proved ineffective.
• Despite interventions including parenteral corticosteroids, both patients experienced severe complications, including intestinal perforation and toxic megacolon, leading to fatal outcomes.

Findings:

• The cases underscore the potential for SAC in UC patients even in regions where IBD is perceived as rare.
• Delayed or missed diagnosis of SAC, potentially due to the predominance of infectious colitis, contributed to poor outcomes.
• Treatment challenges included the need to differentiate SAC from infectious colitis and the accessibility of advanced care.

Implications:

• Clinicians in subtropical regions should maintain a high index of suspicion for SAC in patients with UC, especially those presenting with dysenteric symptoms.
• Early and appropriate management of SAC is crucial, even amidst diagnostic uncertainty and potential co-existing infections.
• Improved diagnostic capabilities and timely therapeutic interventions are essential for reducing mortality associated with SAC in underserved regions.