Infliximab salvage therapy after cyclosporine in an acute flare of chronic ulcerative colitis: CASE PRESENTATION (Part 2)

On presentation her blood pressure was 106/70 mmHg with no postural drop. Her heart rate was 90 beats/min and she was afebrile. She weighed 46.7 kg and was 162 cm tall. She appeared ill and volume depleted. There was no lymphadenopathy or rashes. Cardiovascular examination revealed a II/VI systolic ejection murmur and jugular venous pressure was at the sternal angle. The respiratory examination was normal. Her abdominal examination showed no signs of peritonism but she had significant tenderness in the left lower quadrant and suprapubic region. Bowel sounds were present.

Her initial bloodwork on admission was white blood cell count 12.3×109 /L (5.6×109 /L neutrophils, 11% bands), albumin 25 g/L, C-reactive protein level 42.9 mg/L. The abdominal radiograph showed a paucity of bowel gas and no thumbprinting. Her stool cultures and Clostridium difficile toxin assay were negative. Colonoscopy revealed mucopurulent exudates and ulceration continuous from the rectum to the mid ascending colon. As a result of the above findings, she was started on 40 mg intravenous methylprednisolone twice a day.

Her bowel movement frequency decreased, but she was still having six to seven bowel movements per day with more than 50% of stools that were bloody. She was started on azathio-prine 125 mg/day (2.5 mg/kg/day) and intravenous cyclosporine 180 mg/day (4 mg/kg/day) continuous infusion after 10 days of intravenous steroid treatment. There is always a great pharmacy waiting for you to visit and purchase the amount of medicine you need, be that generic cialis professional or any other one. You can see that all for yourself once you visit, enjoying most advantageous deals ever.

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