Clinical Case Summary
Approximately 20% of patients with Ulcerative Colitis (UC) develop Acute Severe UC (ASUC), for which intravenous systemic steroid therapy and possibly Infliximab-based rescue therapy is generally imposed. However, there are no significant guideline recommendations on ASUC regarding Vedolizumab as an alternative to Infliximab. A 56-year-old male, non-obese, past smoker, with steroid-dependent UC on therapy with mesalazine and therapeutic-targeted azathioprine developed ASUC induced by second-line chemotherapy (for development of colitis pembrolizumab-induced by immunotherapy set in the first line) with gemcitabine plus carboplatin for treatment of recurrence of right pleomorphic lung carcinoma with lower lobe involvement as well as lymph node to hilar and paratracheal sites (primary tumor, G3, arising on the left lung and treated with left pneumectomy). Treatment with intravenous methylprednisolone was imposed; however, there was no reduction in bowel movements in the days following admission. Rescue therapy with Infliximab was contraindicated because of the oncologic history. Surgical consultation contraindicated colectomy and abdomen computerized tomography showed no megacolon. Administration of Vedolizumab 300 mg was initiated. After infusion with Vedolizumab, there was a significant reduction in bowel movements starting the day after infusion until normalization of bowel movements within three days and the concomitant normalization of inflammatory indices. Enteral feeding was reintroduced since parenteral nutrition was set up in the previous days under clinical nutritionist consultation with customized nutritional bags. The patient is currently in clinical remission and on therapy with Vedolizumab 108 mg subcutaneously every two weeks and is in oncologic follow-up for pulmonary neoplasm. This case highlights a novel potential of Vedolizumab as a possible rescue therapy in ASUC, especially in special populations, where it may offer a better safety profile.
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