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1: BMC Gastroenterol. 2005 Jan 24;5:3.Click here to read Click here to read Links

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

Miner J, Gillan MM, Alex P, Centola M.

University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. Jminer@ouhsc.edu

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.

PMID: 15667650 [PubMed - indexed for MEDLINE]

PMCID: PMC548304

Patient Drug Information

  • Prednisone (Prednisone Intensol® , Sterapred® , Sterapred® DS)

    Prednisone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Prednis...

  • Vancomycin (Vancocin® )

    Vancomycin is used to treat colitis (inflammation of the intestine caused by certain bacteria) that may occur after antibiotic treatment. Vancomycin is in a class of medications called glycopeptide antibiotics. It works ...

  • Metronidazole Oral (Flagyl® , Flagyl® 375, Flagyl® ER, ...)

    Metronidazole eliminates bacteria and other microorganisms that cause infections of the reproductive system, gastrointestinal tract, skin, vagina, and other areas of the body. Antibiotics will not work for colds, flu, or...

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