Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab
Shinji Okabayashi1, Taku Kobayashi1, Tomohisa Sujino1
1Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
Intestinal Research
|November 17, 2017
Summary
Extensive ileal inflammation, a rare complication of ulcerative colitis (UC), can occur even when colon inflammation improves. This case highlights the need to investigate small intestine inflammation in UC patients with unexplained worsening symptoms.
Area of Science:
- Gastroenterology
- Internal Medicine
- Inflammatory Bowel Disease
Background:
- Ulcerative colitis (UC) typically involves the colon, with rare extracolonic gastrointestinal involvement, especially in the upper tract or postoperatively.
- Ileal inflammation in UC is uncommon and often responsive to corticosteroids.
Purpose of the Study:
- To report a rare case of ulcerative colitis with extensive, steroid-refractory ileal inflammation.
- To emphasize the importance of investigating small intestinal lesions in UC patients with refractory disease.
Main Methods:
- Case report of a 20-year-old male diagnosed with ulcerative colitis.
- Diagnostic workup included computed tomography, capsule endoscopy, and balloon-assisted enteroscopy.
- Treatment involved initial mesalazine and prednisolone, followed by adalimumab and 6-mercaptopurine.
Main Results:
- The patient presented with pancolitis initially, but developed severe ileal inflammation refractory to multiple courses of steroids.
- Endoscopic and imaging studies confirmed diffuse mucosal inflammation and ulcers in the ileum, while colonic inflammation improved.
- Combination therapy with adalimumab and 6-mercaptopurine achieved clinical and endoscopic remission.
Conclusions:
- Extensive ileal inflammation can be a challenging complication of ulcerative colitis, even in the absence of significant colonic disease.
- Small bowel evaluation is crucial for patients with UC experiencing unexplained clinical deterioration.
- Advanced endoscopic techniques are valuable in diagnosing and managing such rare presentations of UC.
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