Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report

• Main Authors: Alex Philip, Gillan M Monem, Miner Jonathan, Centola Michael
• Format: Article
• Language: English
• Published: BMC 2005-01-01
• Series: BMC Gastroenterology
• Online Access: http://www.biomedcentral.com/1471-230X/5/3

<p>Abstract</p> <p>Background</p> <p>Increasing evidence elucidating the pathogenic mechanisms of ulcerative colitis (UC) has accumulated and the disease is widely assumed to be the consequence of genetic susceptibility and an abnormal immune response to commensal bacteria. However evidence regarding an infectious etiology in UC remains elusive.</p> <p>Case presentation</p> <p>We report a provocative case of UC with profound rheumatologic involvement directly preceded by <it>Clostridium difficile </it>infection and accompanying fever, vomiting, bloody diarrhea, and arthritis. Colonic biopsy revealed a histopathology suggestive of UC. Antibiotic treatment eliminated detectable levels of enteric pathogens but did not abate symptoms. Resolution of symptoms was procurable with oral prednisone, but tapering of corticosteroids was only achievable in combination therapy with vancomycin and metronidazole.</p> <p>Conclusions</p> <p>An infectious pathogen may have both precipitated and exacerbated autoimmune disease attributes in UC, symptoms of which could be resolved only with a combination of corticosteroids, vancomycin and metronidazole. This may warrant the need for more perceptive scrutiny of <it>C. difficile </it>and the like in patients with UC.</p>