A 53-year-old diagnosed w...

A 53-year-old man was diagnosed with Ulcerative colitis (proctitis type) at 48 and maintained remission for five years. Then, however, he had complained of worsening abdominal pain and bloody diarrhoea. Colonoscopy showed that inflammation extended to the whole colon, and he was treated with medication consisting of 5-ASA, granulocytapheresis (twice a week), and high-dose prednisolone. Still, bloody diarrhoea did not improve, and anaemia progressed such that blood transfusions were necessary. 

The results of the blood examination were: WBC: 13,630 μl, Hb:9.6 g/dl, serum albumin 2.4 g/dl, and CRP: 5.7 mg/dl. Plain X-ray showed dilatation of the transverse colon, reaching diameters of 5.5 cm. The colonoscopy performed before starting therapy showed oedema, multiple ulcers, and spontaneous bleeding (left figure). Multiple ulcers had disappeared due to the treatment

After we had obtained full informed consent from the patient, oral tacrolimus medication was started at a dose of 0.05mg/kg. One week later, bloody diarrhoea had disappeared, and anaemia had improved. Oral tacrolimus was continued for three months, and the patient started azathioprine (25 mg/day) 1 month before the cessation of tacrolimus.