Infliximab salvage therapy after cyclosporine in an acute flare of chronic ulcerative colitis: CASE PRESENTATION (Part 3)

Intravenous cyclosporine was continued for 14 days. She felt well enough to be discharged from hospital. On discharge, she was having three small diarrheal stools and her abdominal pain improved. She was discharged on azathioprine 125 mg/day (2.5 mg/kg/day), cyclosporine (Neoral, Novartis Pharmaceuticals, USA) 175 mg (3.75 mg/kg/day) and budes-onide enemas. She was required to have weekly complete blood counts and cyclosporine C0 levels.

The patient was readmitted a week later after worsening symptoms. She continued to be fatigued and had crampy lower abdominal pain. Her bowel movement frequency increased to 12 bloody bowel movements per day. After a frank discussion about the available options, the patient decided that she was not ready for colectomy. The patient knew that she may eventually require a colectomy but wanted to try medical therapy once more. Infliximab infusion (5 mg/kg) was given. Oral cyclosporine was discontinued at the start of infliximab therapy.

Within two days, her bowel frequency decreased to three semi-formed, non-bloody stools per day and her abdominal discomfort improved. She was discharged on azathioprine 125 mg/day (2.5 mg/kg/day). The patient had relief from her symptoms for approximately 10 days before relapsing with bloody diarrhea and fatigue. Outpatient laboratory exam 10 days after the infliximab revealed white blood cell count 6.1×109 /L, hemoglobin 86 g/L and platelet count 709×109 /L. The patient received a second infliximab infusion (5 mg/kg) two weeks after the initial infusion. She did not have a clinical improvement from the second infusion and subsequently underwent colectomy. Buy best quality medications online at the pharmacy that will make sure your are happy with the prices and the quality of your generic viagra professional online whenever you need some treatment and have no idea where to get it.

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