Patient history. Treatment of ulcerative colitis
NewsPatients with inflammatory bowel diseases, which include ulcerative colitis and Crohn's disease, are at risk if they become infected with COVID-19. This is due to the fact that they need to take immunosuppressive therapy constantly or in courses, depending on the severity of the disease.
The patient followed all the recommendations and constantly took prescribed anti-inflammatory intestinal drugs, which gave a positive effect. At the same time, he was not prescribed immunosuppressive therapy due to the mild degree of the disease.
But in 2018, his condition worsened. He had diarrhea up to 8-10 times a day, an admixture of blood in the stool, abdominal pain. After the examination, it turned out that the disease had turned into a severe degree.
In this case, the doctors prescribed a course of immunosuppressive therapy with glucocorticosteroids. The treatment helped, the patient felt much better, the stool normalized. However, after discontinuation of therapy, a relapse occurredagain .
To overcome hormone dependence, he was recommended constant immunosuppressive therapy with azathioprine. And then for 2 years he felt good, followed the recommendations and took the prescribed medications.
In February 2020, the patient independently decided to cancel the immunosuppressive therapy, because he was afraid that this could increase the risk of contracting a coronavirus infection. And after a month, I felt bad again: there was mucus and blood in the stool, weakness, and abdominal discomfort.
In April 2020, the patient was hospitalized in the MCSC with complaints of diarrhea up to 10-12 times a day with an admixture of blood and mucus, and an increase in body temperature to 38C.
Our specialists performed a sigmoscopy and found signs of high activity ulcerative colitis: multiple ulcerative defects in the rectum and sigmoid colon.
ThenUltrasound of the intestine showed that there are inflammatory changesin the colon, but the activity is most pronounced in the sigmoid colon. 
As a result, the doctors of our Center prescribed the patient a combination therapy, which also included immunosuppressive drugs. Thanks to this, it was possible to stop the attack of ulcerative colitis, avoid surgical complications and achieve remission of the disease.
After that, the patient was discharged in good condition, he was given recommendations for continuous anti-inflammatory and immunosuppressive therapy.
What is important to know?
The majority of patients with IBD who constantly take immunosuppressive therapy fall into the categories of low and moderate risk of contracting coronavirus infection.
However, it was found that those patients who receive immunosuppressive biological anti-cytokine therapyare less likely to have such a complication of COVID-19 as a "cytokine storm".
- A cytokine storm is an uncontrolled inflammationthat causes damage to the body's own tissues. In the fight against the virus, immune cells secrete special substances-cytokines
- These proteins act according to the relay principle: the effect of the cytokine on the cell causes the formation of other cytokines by it
- If the reaction of the immune system is very strong, there is a so-called " cytokine storm»: activated immune cells produce more and more portions of these proteins
Thus, immunosuppressive anti-cytokine therapy is used to treat the "cytokine storm" in coronavirus infection. Therefore, we recommend that all patients with IBD do not independently cancel the treatment prescribed by their doctor and continue taking medications.
Discontinuation of therapy will increase the likelihood of exacerbation of IBD and increase the risk of complications with coronavirus infection.
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