H R Chitme
Oman Medical College, Oman
Posters & Accepted Abstracts: J Clin Case Rep
A 29-year-old male patient having eight-year history of ulcerative colitis with multiple ulcerative colitis exacerbations is on maintenance therapy. Colonoscopy established pancolitis extending from cecum to rectum with the presence of granularity, ulcers, hemorrhage and moderately active disease. It is also noted with hyperplastic mucosal nodules in the prolapsing rectum. This patient was diagnosed with ulcerative colitis only in 2001 treated in the past with mesalamine, azathioprine, adalimumab, infliximab, prednisone and hydrocortisone with antibiotic rifaximin and albendazole with an inadequate improvement in his condition. He is still suffering from multiple watery stools with blood and mucus sometimes and complains of abdominal distention with excessive flatus. Colonoscopy reconfirms active pancolitis with multiple small to medium size ulcers. He refused to go for colectomy advised by consultant. Therefore, it was recommended to change the current adalimumab to weekly infliximab with current azathioprine and mesalamine. Follow-up laboratorial investigation reveals that his hemoglobin, hematocrit, along with MCV, MCHC are lower than normal and random blood glucose, platelet count, RDW are higher than the normal. However, overall symptoms and quality of life of the patient have improved compared to earlier therapies. This case demonstrates and supports that combination of weekly infliximab infusion and oral azathioprine while maintaining remission with mesalazine may be beneficial in inducing remission rapidly, even in moderate cases of steroid-dependent ulcerative colitis.
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