Late-Onset of Acute Severe Ulcerative Colitis: Clinical Case

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Case Study

Background:

• Late-onset ulcerative colitis (UC) in adults often exhibits a more aggressive clinical course compared to younger patients.
• Early diagnosis and management are crucial as UC in older adults may be linked to precancerous conditions.

Observation:

• A 57-year-old male presented with acute severe UC symptoms including bloody diarrhea, abdominal pain, urgency, and dehydration.
• Initial colonoscopy revealed diffuse inflammation, erosions, and ulcers; histological evaluation favored UC.
• The patient showed limited response to mesalazine and oral steroids, necessitating intravenous steroids and subsequently infliximab.

Findings:

• Initial treatment with mesalazine and prednisone yielded suboptimal results.
• Intravenous dexamethasone provided partial improvement, but infliximab induction therapy led to significant symptom reduction.
• The patient developed herpes zoster infection during treatment, requiring famciclovir, but continued infliximab maintenance therapy achieved stable remission.

Implications:

• This case underscores the importance of considering late-onset UC and its potential aggressive nature.
• It demonstrates the efficacy of infliximab in managing severe, late-onset UC refractory to conventional therapies.
• The case also highlights the need for vigilance regarding opportunistic infections, such as herpes zoster, during immunosuppressive therapy for UC.