PMC5832071_01
Endoscopic evaluation on presentation. Severe colitis seen throughout the colon.
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A flexible sigmoidoscopy performed shortly after admission showed severe colitis with deep ulcerations, absent vascular pattern, and friable mucosa in the transverse and sigmoid colon (Figure 1).
Endoscopic evaluation after failed trial on oral steroids. Severe colitis seen up to 40 cm; further evaluation was limited given degree of inflammation.
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A repeat flexible sigmoidoscopy demonstrated edematous mucosa with loss of vascularity and scattered ulcers from anus to 15 cm and deep large ulcers with friable mucosa and spontaneous bleeding from 15 cm to 40 cm (Figure 2).
Charted weights. Significant weight loss seen on presentation (blue arrow). Red arrows: indication dates of infliximab administration with the corresponding weight gain.
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The patient responded well after two doses of infliximab (10 mg/kg) with improved bloody diarrhea to three times per day and 15-pound weight gain within the first month (Figure 3).