Ulcerative Colitis: A Woman With Venous Thromboembolism and Inflammatory Bowel Disease
Adam Faye, MD, MS; Aasma Shaukat, MD, MPH | NYU Langone, NY
A 64-year-old woman presents to your emergency department with worsening diarrhea and rectal bleeding for the past 3 days. She has a history of ulcerative colitis (UC) and is only on mesalamine therapy. Imaging shows pancolitis without any concern for megacolon or perforation. Stool studies ruled out Clostridioides difficile or other infectious etiologies. Flexible sigmoidoscopy shows moderate disease with friability, erosions, and erythema consistent with colitis Mayo Score of 3. Biopsies were performed and confirm moderate to severe chronic colitis; they were negative for cytomegalovirus (CMV).
You start her on intravenous corticosteroids in the hospital and see a significant reduction in the number of stools in the first 24 hours. Rectal bleeding has also decreased but not completely resolved, so pharmacologic venous thromboembolism (VTE) prophylaxis is withheld. Your patient continues to improve and is near discharge 2 days later when she becomes acutely tachycardic and dyspneic.
Your patient likely has a pulmonary embolus, as the presence of inflammatory bowel disease (IBD) increases the risk of VTE 2- to 3-fold.1 Additionally, this risk increased during periods of active inflammation, during hospitalization, as a result of corticosteroid therapy, and among older adults.2
References:
1.Cheng K, Faye AS. Venous thromboembolism in inflammatory bowel disease. World J Gastroenterol. 2020;26(12):1231-1241. doi:10.3748/wjg.v26.i12.1231
2. Lambin T, Faye AS, Colombel JF. Inflammatory bowel disease therapy and venous thromboembolism. Current Treatment Options in Gastroenterology. 2020;18:462-475. doi:10.1007/s11938-020-00304-z
