Objective: This case report aims to show the clinical course and management of ulcerative colitis which responded to systemic corticosteroid therapy
Design: Case Report
SETTING: Tertiary hospital
Case Report: A 32 year old male was admitted with a chief complaint of diarrhea. On physical examination, patient was conscious, coherent, not in distress. He was febrile with temperature of 38°C, tachycardic with pulse rate of 108. He was cooperative but weak looking. His abdomen was flat, soft, normoactive, with direct tenderness on the left lower quadrant. Digital Rectal Exam showed no skin tags, non-tenderness, full rectal vault, with blood on tactating finger. Admitting impression was TB of the colon versus amebic colitis and inflammatory bowel disease. Colonoscopy was done which revealed nodular colonic mucosa with cobblestone appearance with multiple ulcers and erosions. Rectal biopsy was done and specimen was sent to the histopathology section which revealed ulcerative colitis. On the 4th hospital stay, still with abdominal pain, Tramadol was given which afforded slight relief. He was maintained on Prednisone 20 mg TID for 2 weeks as outpatient management. On the following day, patient was slightly relieved of symptoms and was discharged improved. He was maintained on Prednisone 20 mg tablet TID for 2 weeks and was advised to have repeat sigmoidoscopy after a month. On follow-up, endoscopy was done and revealed remission of the disease.
CONCLUSION: Early diagnosis and classification of ulcerative colitis as to severity is necessary in the choice of medical management. Corticosteroids represent the first line therapy for moderate to severe ulcerative colitis. Newer agents are available as alternative to steroid management.