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

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...

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Autores principales: Miner, Jonathan, Gillan, M Monem, Alex, Philip, Centola, Michael
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2005
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC548304/
https://www.ncbi.nlm.nih.gov/pubmed/15667650
http://dx.doi.org/10.1186/1471-230X-5-3
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author Miner, Jonathan
Gillan, M Monem
Alex, Philip
Centola, Michael
author_facet Miner, Jonathan
Gillan, M Monem
Alex, Philip
Centola, Michael
author_sort Miner, Jonathan
collection PubMed
description 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.
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spelling pubmed-5483042005-02-06 Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report Miner, Jonathan Gillan, M Monem Alex, Philip Centola, Michael BMC Gastroenterol Case Report 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. BioMed Central 2005-01-24 /pmc/articles/PMC548304/ /pubmed/15667650 http://dx.doi.org/10.1186/1471-230X-5-3 Text en Copyright © 2005 Miner et al; licensee BioMed Central Ltd.
spellingShingle Case Report
Miner, Jonathan
Gillan, M Monem
Alex, Philip
Centola, Michael
Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report
title Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report
title_full Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report
title_fullStr Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report
title_full_unstemmed Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report
title_short Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report
title_sort steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC548304/
https://www.ncbi.nlm.nih.gov/pubmed/15667650
http://dx.doi.org/10.1186/1471-230X-5-3
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