Infliximab salvage therapy after cyclosporine in an acute flare of chronic ulcerative colitis: CASE PRESENTATION (Part 1)

A 24 year-old white woman with CUC presented with a five-day history of more than 12 large volume bloody diarrhea per day. She had crampy left lower quadrant abdominal pain and worsening fatigue over the preceding two weeks. There was no antecedent upper respiratory tract infection, nonsteroidal antiinflammatory medications or antibiotic use. She had significant tenesmus. There was no fever or chills. There were no extraintestinal manifestations of inflammatory bowel disease.

She had flares of her ulcerative colitis every two years. Each flare in the past responded to steroid or mesalamine enema therapy. She was started on oral steroids (prednisone 40 mg/day) for the current flare and topical budesonide enemas with marginal impact on her symptoms. After one week of therapy, her bowel movements decreased to 10 per day. She was not improving as an outpatient and was hospitalized.

The patient was originally diagnosed with ulcerative colitis 13 years earlier when she presented with a history of intermittent rectal bleeding for one year. Endoscopic findings in 1989 revealed mucopurulent exudates with friability distal to the splenic flexure at the initial colonoscopy. There was no terminal ileal or cecal involvement. A small bowel follow through was also normal. Her ulcerative colitis had responded to steroids and she had been maintained on mesalamine (4 g/day). The patient was aware that colectomy would be curative but had always responded to medical therapy. She wanted to delay surgery until it was absolutely necessary. Yearly surveillance colonoscopy was started 10 years after the disease was diagnosed and all subsequent colonoscopies showed quiescent disease and no dysplasia on four quadrant biopsies every 10 cm in the left colon. Your shopping for best quality medications is going to be pleasant and very affordable every time: make sure of it yourself when you visit the best pharmacy to buy viagra professional canadian pharmacy  as this is the kind of experience every patient is looking forward to.

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