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

doi:10.1186/1471-230X-5-3

BMC Gastroenterology
Volume 5

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Case report

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

Jonathan Miner¹^,2 , M Monem Gillan² , Philip Alex¹^,2 and Michael Centola¹^,2

¹University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104 USA

²Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104 USA

author email corresponding author email

BMC Gastroenterology 2005, 5:3doi:10.1186/1471-230X-5-3


Published:	24 January 2005

Abstract

Background

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.

Case presentation

We report a provocative case of UC with profound rheumatologic involvement directly preceded by Clostridium difficile 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.

Conclusions

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 C. difficile and the like in patients with UC.