Case Report: Medical Management of Acute Severe Ulcerative Colitis

A 29-year-old female patient presented 5 years ago with bloody diarrhea, fecal urgency, and crampy abdominal pain. A colonoscopy was performed, which revealed diffuse loss of vascular pattern and superficial ulcers throughout the colon with a normal terminal ileum. Histopathologic examination of colonic biopsies showed chronic inflammatory changes with cryptitis, crypt abscesses, and architectural distortion of crypts. On this basis, the patient was diagnosed with ulcerative colitis (UC) and began receiving 5-aminosalicylic acid (4.8 g/day). After an initial period of remission, she experienced flare-ups requiring oral corticosteroids, azathioprine (2 mg/kg), and then vedolizumab (Entyvio, Takeda; 300 mg intravenously at weeks 0, 2, and 6, followed by every 8 weeks).