Abstract
Ulcerative colitis has hypercoagulable state and high risk of thrombosis; so mucosal disturbance of microcirculation may be mediate and amplify the inflammation of ulcerative colitis. A 56-year-old female patient was admitted in hospital for discontinuously mucous bloody stool for more than 1 year. Ulcerative colitis was determined after colonoscopy and pathologic examination. Mesalazine was effective during the year, but her symptoms recurred three times due to her bad compliance. One month before admission, the patient had severe recurrence after mesalazine withdrawal. At this time, the result of quantitative fluorescence PCR of colonic histic CMV-DNA was 1.6 × 104 copies/mL positive, CMV colitis was accompanied. After 4 weeks of ganciclovir and 6 weeks of mesalazine usage and nutrition support, the symptoms of diarrhea and abdominal cramp did not improve; stool frequency was more than twenty times a day. Probe-based confocal laser endomicroscopy revealed local microcirculation disturbance. Papaverine 90-mg slow drip for at least 10 h a day was added. The symptoms dramatically disappeared after 3 days of papaverine treatment. The patient had yellow mushy stool 2–3 times a day. Pathological findings showed diffuse submucosal hemorrhage and transparent thrombosis in capillaries. Treatment of microcirculatory disturbance in severe UC is a promising adjuvant therapy. Confocal laser endomicroscopy may be an effective method for microcirculation judgment.
Highlights
Ulcerative colitis (UC) has hypercoagulable state, the risk of thrombosis increases
There is evidence that coagulation activation may in turn mediate and amplify inflammatory cascades in inflammatory bowel disease (IBD) [3]
Similar findings were observed in animal models of colitis with vasodilator papaverine (PAP) [5]
Summary
Ulcerative colitis (UC) has hypercoagulable state, the risk of thrombosis increases. It suggests that the formation of microthrombosis may be one of the important pathogeneses of UC [1]. One month before admission, when the patient went out for travel and stopped using mesalazine, the mucous blood stool gradually increased to more than 20 times a day, dark red blood stool when symptom got serious, accompanied by lower abdominal pain before defecation, general weakness, loss of appetite and 10-kg weight loss within 1 month. During these days, there were no other special medication usage and no rashes appeared. She was discharged from hospital and continued to take mesalazine 4 g/day to treat the disease
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