Resolution of amyloidosis (AA type) complicating chronic ulcerative colitis

A 36-yr-old woman was admitted for the investigation of diarrhea, fever, weight loss, and a recurrent painful, red eruption on her forearms. She was found to have total colonic involvement with a nonspecific ulcerative colitis. Vascular and extravascular amyloid (AA type) was present in biopsy specimens of the colon, duodenum, and stomach. There was clinical and radiographic evidence of splenic and hepatic amyloidosis. Moreover, the presence of extravascular colonic amyloid, the absence of renal involvement, the relatively early detection of amyloid, and the resolution of amyloid after treatment make this case unique.     

Acute pericarditis associated with 5-aminosalicylic acid (5-ASA) treatment for severe active ulcerative colitis

A 17-year-old male who had been diagnosed with ulcerative colitis was prescribed 80 mg prednisolone and 1,500 mg 5-aminosalicylic acid (5-ASA) per day. Two weeks after initiating therapy, he was referred to our hospital for evaluation of chest pain and high fever. Electrocardiography (ECG) showed ST elevation in limb and precordial leads. Chest pain with high fever and ECG changes were resolved after 5-ASA was discontinued. Three weeks later, the administration of a low dose of 5-ASA was associated with the immediate recurrence of pericarditis associated with chest pain, suggesting a hypersensitive reaction to 5-ASA in this patient.     

Recovery from hepatic vein thrombosis (Budd-Chiari syndrome) complicating ulcerative colitis

Summary A 22-year-old female with active ulcerative colitis developed massive ascites, hypoalbuminemia, and hepatomegaly compatible with thrombosis of the hepatic veins. The diagnosis of Budd-Chiari syndrome was confirmed by ultrasonography, computed tomography, and by liver biopsy. A search of the literature disclosed only three previous reports of Budd-Chiari syndrome occurring in patients with ulcerative colitis. All patients have been young females with active colitis and no other known risk factor for the development of hepatic vein thrombosis. Our patient, unlike the previously reported patients who died, recovered sufficiently to be discharged from the hospital.     

Postcolonoscopy appendicitis in a patient with active ulcerative colitis

Complications due to diagnostic colonoscopy are uncommon and acute appendicitis is a very rare complication of colonoscopy. This poses a diagnostic challenge as the presentation of appendicitis is similar to that of other complications of colonoscopy such as perforation or postpolypectomy syndrome. It is hypothesized that postcolonoscopy appendicitis might be associated with obstruction of the appendiceal lumen with fecal matter during colonoscopy. None of the previous reports in the literature have described findings of appendicitis after colonoscopy in a patient with active ulcerative colitis. We present a case of a 28 year-old man with active ulcerative colitis who underwent colonoscopy and subsequently developed acute appendicitis.     

Survival of patients with colorectal cancer complicating ulcerative colitis

The crude five year survival of patients with colorectal cancer complicating ulcerative colitis in a large series of patients under long term review has, for the first time, been compared with the survival of patients with colorectal cancer in the general population (West Midlands region) from which the colitic patients were drawn. Thirty five cases of colorectal cancer were diagnosed in 676 patients with ulcerative colitis between 1944 and 1976. An actuarial five year survival curve was computed for the colitic and non-colitic patients with colorectal cancer. In ulcerative colitis patients with cancer the five year survival was 33.5% (range 16.9-50.1%) compared with 32.6% (28.2-37.0%) in the non-colitic cancer patients drawn from the relevant general population. Overall the prognosis is much better than earlier reports suggest. It is perhaps disappointing that in a closely monitored group the outcome is only as good as that in the general population. Surveillance programmes should improve the outcome in those patients with ulcerative colitis who accept the need for regular review.     

Two thrombotic complications in a patient with active ulcerative colitis

A 30-year-old woman is described with both a cerebral venous thrombosis and a deep vein thrombosis of her leg in association with an exacerbation of her ulcerative colitis. Laboratory investigations revealed a transient functional APC resistance, without Factor V mutation, and a mild hyperhomocysteinaemia. After colectomy the APC ratio was normal. These findings may form a partial explanation of the thrombophilia seen in some patients with active ulcerative colitis.     

Acute CMV-colitis in a patient with a history of ulcerative colitis

A symptomatic cytomegalovirus (CMV) infection usually occurs in patients with debilitating diseases, immunosuppression, transplantations and acquired immunodeficiency syndrome (AIDS). Gastrointestinal infections with CMV, especially colitis, are usually found in immunocompromised patients and rarely affect immunocompetent subjects. Here we report the case of a young female patient with a history of ulcerative colitis (UC) who presented with an acute attack of colitis caused by CMV infection. This was documented by the presence of CMV early antigen, antibodies and evidence of CMV in the colonic mucosa. After combined anti-inflammatory and antiviral treatment the patient recovered completely. As most attention is given to CMV-pathogeneity in immunocompromised patients, here we discuss the relationship to inflammatory bowel diseases.     

Octreotide in patients with active ulcerative colitis treated with high dose corticosteroids (OPUS 1)

BACKGROUND : In ulcerative colitis the intestinal somatostatin content is reduced. Somatostatin has several immune-inhibitory effects. In vitro it diminishes activity of intestinal lymphocytes and peripheral blood monocytes. Its long-acting analogue octreotide has beneficial effects on mucosal damage in acute experimental acetic acid colitis in rats. AIMS : To determine the potential benefits of octreotide as a treatment for patients with severe ulcerative colitis treated with high dose corticosteroids. PATIENTS : Forty-two patients with severe ulcerative colitis (more than 10 points on the Powell-Tuck scoring system and mucosal disease Heatly grade III or IV). METHODS : In a multi-centre, double blind, placebo-controlled trial all patients were treated with oral 5-ASA (1.6-2.4 g daily) and high dose corticosteroids (tapering off from 60 to 80 mg daily). They were randomly assigned to receive subcutaneous placebo (n = 22) or octreotide 500 microg (n = 20) thrice daily during 21 days. Clinical and endoscopic disease activity, histology and laboratory parameters were obtained during the study period. RESULTS : Clinical disease activity for both octreotide and placebo were not significantly different at baseline and after 21 days of treatment. Endoscopic disease activities (mean +/- SD) changed from 12.5 +/- 4.7 to 7.2 +/- 5.3 for octreotide, and from 11.5 +/- 5.0 to 5.0 +/- 3.4 for placebo (NS). Seven patients from both groups received additional treatment (colectomy (n = 6), cyclosporin (n = 1)). Adverse events occurred equally in both groups. CONCLUSIONS : Subcutaneous administration of octreotide 500 microg thrice daily is not of additional benefit as adjuvant therapy to high dose corticosteroids in severe ulcerative colitis.     

Acute myelogenous leukemia in patients with ulcerative colitis

Of approximately 400 patients with ulcerative colitis admitted to the Mount Sinai Hospital in New York City during 1970-1978, five developed acute myelogenous leukemia in the course of their illness. This association may be more than fortuitous.     

Fibrolamellar hepatocellular carcinoma complicating ulcerative colitis with primary sclerosing cholangitis.

This case report describes the previously undocumented association between fibrolamellar hepatocellular carcinoma and ulcerative colitis complicated by primary sclerosing cholangitis.     

Acute myocardial infarction in a young woman with severe ulcerative colitis

In this report we present a case of a 28-year-old woman who was admitted to our emergency room complaining of chest pain. Her clinical ECG and biochemical evaluation was consistent with acute nonatherogenic myocardial infarction. Subsequent work is revealed that she was suffering from ulcerative colitis with acute exacerbation since last week. We discussed triggering factors for thrombogenic and inflammatory tendency of patient with comprehensive review of literature to clarify the causal relationship.     

Cerebral sinus thrombosis associated with severe active ulcerative colitis

A 19-year-old man with severe active ulcerative colitis was admitted to our hospital where he was prescribed 80 mg prednisolone and underwent leukocytapheresis (LCAP). Two weeks after initiating therapy, his symptoms had not recovered. We administered cyclosporin via continuous intravenous infusion for 12 days. Although his clinical symptoms improved, he complained of severe headache. Immediate plain computed tomography (CT) and magnetic resonance imaging angiography (MRA) revealed extensive thrombosis in the superior sagittal sinus and right transverse sinus. We treated this condition with the anticoagulant agent, heparin, which prevents and can treat venous thrombosis. We report an occurrence of cerebral sinus thrombosis accompanying ulcerative colitis, where active anticoagulant therapy was useful.