Ulcerative colitis. MCSC patient historyOct 1, 2019
Choice of treatment tactics for tuberculosis
Patient S., 34, sought advice from the MCSC with complaints of lower abdominal pain and loose stools up to 10 times a day with an admixture of mucus and blood, which appeared in her in 2012. She was examined in the department of inflammatory bowel diseases, where she was diagnosed with ulcerative colitis, a total lesion. The doctor prescribed Mesalazine and systemic glucocorticosteroids with a gradual dose reduction, which gave a positive effect.
In 2017, the patient was diagnosed with tuberculosis of the left lung. She underwent long-term specific treatment, but no improvement occurred, and she was recommended surgery-removal of the upper lobe of the left lung.
Shortly after the operation, the patient experienced an exacerbation of ulcerative colitis. She underwent a colonoscopy and found deep polygonal ulcers up to 1 cm in diameter, reaching the muscle layer.
Doctors also conducted a more in-depth examination of the patient, but intestinal tuberculosis was not confirmed, and she was prescribed hormone therapy, which caused only a short-term positive effect.
In April 2018 she was again admitted to the Department of Inflammatory Bowel Diseases of the MCSC. Our specialists confirmed the diagnosis: the patient maintained the inflammatory activity of ulcerative colitis. In this regard, and taking into account the long-term exacerbation of the disease, the use of hormonal drugs, as well as tuberculosis, she was prescribed therapy with the biological drug Vedolizumab. It can be prescribed for a history of tuberculosis, while other biological drugs have a greater risk of its recurrence.
However, a few months later, when the patient came for a control examination, the treatment was found ineffective: according to the results of a colonoscopy, she had colon ulcers. Vedolizumab was replaced with a drug with a different mechanism of action – Tofacitinib.
After 3 months, a control examination was performed. The patient has confirmed not only clinical, but also endoscopic remission of ulcerative colitis.
Ulcerative colitis is a severe inflammatory bowel disease, when a person's immune system works against their own organ-the colon. Currently, the cause of it is unknown, but the success of medicine is aimed at creating new active methods of treatment with genetically engineered biological drugs that can suppress the body's immune response against its own organ (intestine) and, thereby, help to achieve remission of the disease. In this case, the patient suffered from pulmonary tuberculosis, which is a contraindication for biological therapy, but thanks to timely diagnosis and properly prescribed treatment, our doctors managed to achieve remission of the disease.
Specialists of the Department of Inflammatory Bowel Diseases of the MCSC have extensive experience in the diagnosis and management of patients with ulcerative colitis. Especially in severe concomitant diseases that create "pitfalls" on the way to achieving reliable remission of ulcerative colitis and other inflammatory bowel diseases.