Disseminated Intravascular Coagulopathy and Newly Diagnosed Ulcerative Colitis, a Rare but Serious Complication: A Case Report: 2017 Presidential Poster Award

Abstract

Ulcerative colitis has various extraintestinal manifestations, including coagulation disorders, however the presence of disseminated intravascular coagulation (DIC) is rare. The current case depicts a patient in whom DIC arose secondary to damage of the endothelium of colonic blood vessels. A 19 year-old female was admitted with abdominal pain, nausea, emesis, and hematochezia. Abdominal CT scan suggested extensive colitis and colonoscopy confirmed Mayo grade 3 ulcerative pancolitis. The patient subsequently developed extensive thromboses, anemia, and purpura fulminans. Her laboratory evaluation was consistent with DIC. Because she failed to respond to corticosteroids and infliximab induction, total proctocolectomy with end-ileostomy was performed, which led to resolution of DIC. DIC involves mechanical and/or endothelial cell injury, and thus, intestinal vasculature may play a key role in thrombosis in IBD. IBD results in destructive inflammation of the GI tract, and chronic inflammation of endothelial cells and microvasculature of the GI tract precipitates physiologic and functional alterations in contrast to uninvolved intestine. The damaged microvasculature subsequently has decreased perfusion and stenosis, which may predispose patients to hypercoagulability [1]. In our patient, the underlying cause of coagulopathy was fulminant UC that was unresponsive to corticosteroid and biologic therapy. Ultimately, surgical intervention with total colectomy resulted in rapid improvement of DIC parameters. In conclusion, we report a rare case of an association of DIC and UC which can be managed with timely diagnosis and appropriate therapeutic management of the underlying condition.