Low-dose intravenous azathioprine may be effective in the management of acute fulminant colitis complicating inflammatory bowel disease.
BACKGROUND
The management of acute fulminant colitis unresponsive to intravenous steroids is usually surgical. However, recent evidence suggests that intravenous administration of azathioprine at very high doses may allow more rapid onset of clinical efficacy, although its use has not previously been reported in the emergency situation.


OBJECTIVE
To report the successful use of intravenous azathioprine in the management of acute fulminant colitis complicating both Crohn's disease and ulcerative colitis.


METHODS
We initially used intravenous azathioprine because of the refusal of the family of the first patient to accept surgery following failure of conventional medical management. Importantly the azathioprine was successful at the low dose of 3 mg/kg.day, equivalent to standard oral doses. Two subsequent patients demonstrated a similar resolution. All were weaned successfully to oral azathioprine and have remained in long-term endoscopic and histological remission.


CONCLUSIONS
These preliminary data suggest that low-dose intravenous azathioprine may be helpful adjunct therapy in selected cases of severe fulminant colitis. However, the need for close monitoring and daily surgical assessment remains paramount, and a formal trial of low-dose intravenous azathioprine is required before it may be more widely recommended.
Casson
D H
DH
University Department of Paediatric Gastroenterology, Department of Histopathology, London, UK.
Davies
S E
SE
Thomson
M A
MA
Lewis
A
A
Walker-Smith
J A
JA
Murch
S H
SH
D000208:Acute Disease; D000293:Adolescent; D001379:Azathioprine / Q000008:administration & dosage*; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008297:Male
D007166:Immunosuppressive Agents; D001379:Azathioprine