Fulminant ulcerative colitis complicated by treatment-refractory bacteremia

Area of Science:

• Gastroenterology
• Hepatology
• Infectious Diseases

Background:

• Severe ulcerative colitis (UC) is characterized by frequent bloody stools and systemic toxicity.
• Fulminant UC signifies a more severe presentation with heightened toxicity.
• Standard treatments include corticosteroids and infliximab, with colectomy or cyclosporine reserved for refractory cases.

Observation:

• A 23-year-old Hispanic woman with decompensated cirrhosis developed new-onset fulminant ulcerative colitis.
• The patient also presented with polymicrobial bacteremia, indicating a serious systemic infection.
• This clinical scenario presented a complex management challenge due to the co-existing liver disease and severe colitis.

Findings:

• The patient's condition necessitated surgical intervention for both infection source control and treatment of the severe ulcerative colitis.
• Colectomy was performed, leading to resolution of the bacteremia and management of the colitis.
• This case underscores the critical interplay between liver disease severity and gastrointestinal emergencies.

Implications:

• This case highlights a rare but serious complication of ulcerative colitis in patients with advanced liver disease.
• It emphasizes the importance of considering colectomy in managing fulminant ulcerative colitis complicated by bacteremia, especially in the setting of decompensated cirrhosis.
• Early surgical consultation and intervention may be crucial for favorable outcomes in such complex cases.