Eye damage in a patient with ulcerative colitis. MCSC patient history

News 03/15/2022

In November 2011, patient S., 35 years old, applied to the Polyclinic at his place of residence. He complained about the appearance of blood in the stool. According to the results of colonoscopy, ulcerative colitis is suspected. The man refused medical help. But, periodically, he had impurities of blood in the stool.

In 2016, he was hospitalized in the Department of treatment of inflammatory bowel diseases of the MCSC named after A. S. Loginov. After a comprehensive examination, a diagnosis of ulcerative colitis, left-sided lesion was established. The patient was prescribed anti-inflammatory therapy with Mesalazine. Against the background of treatment, the state of health improved and the stool improved. Taking the medicine is recommended to continue.After 4 years, in 2020, the young man had complaints about:

• redness of both eyes;
• feeling of "sand in the eyes";
• pain and lacrimation;
• impaired vision.

He sought advice from an ophthalmologist, who diagnosed uveitis. This is an inflammation of the choroid of the eye. Prescribed therapy with eye drops gave a temporary positive effect. After a few days, the symptoms resumed, and there was a loose stool up to 5 times a day with an admixture of mucus and blood.

The patient was hospitalized in the IBD treatment Department of the A. S. Loginov MCSC, where he underwent a comprehensive diagnosis:

• according to the blood test, an inflammatory process was noted;
• colonoscopy revealed ulcerative defects on the mucous membrane of the colon, Sigmoid and rectum.
• at the consultation of an ophthalmologist, inflammation of the eyes was confirmed.

Thus, the patient revealed an extra-intestinal manifestation (ECP) of ulcerative colitis – inflammation of the eyes. Taking into account the presence of VCP, biological therapy was initiated, aimed at treating both the main intestinal disease and ophthalmological manifestations of ulcerative colitis. During the control examination, an improvement in the condition was achieved, a decrease in the symptoms of ulcerative colitis and inflammatory changes in the eyes.

According to statistics, 50% of patients with IBD have at least one extra-intestinal manifestation. Often it manifests itself before the diagnosis of ulcerative colitis or Crohn's disease. Extra-intestinal manifestations are diverse. These include:

• eye damage (uveitis, episcleritis);
• damage to the musculoskeletal system (ankylosing spondylitis, arthritis);
• liver disease (Primary Sclerosing Cholangitis);
• aphthous stomatitis;
• erythema nodosum, etc.

Eye damage is detected in 2-10% of patients with an established diagnosis of IBD and often worsens simultaneously with the underlying disease.

The patient's history demonstrates the importance of a multidisciplinary approach in the diagnosis and treatment of IBD, timely detection of extra-intestinal manifestations by specialists of other areas and the alertness of the gastroenterologist in the treatment of a patient with complaints of a non-Gastroenterological profile.

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