title: Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report.
abstract: BACKGROUND
  Increasing evidence elucidating the pathogenic mechanisms of ulcerative colitis (UC) has accumulated and the disease is widely assumed to be the consequence of genetic susceptibility and an abnormal immune response to commensal bacteria. However evidence regarding an infectious etiology in UC remains elusive.
  
  
  METHODS
  We report a provocative case of UC with profound rheumatologic involvement directly preceded by Clostridium difficile infection and accompanying fever, vomiting, bloody diarrhea, and arthritis. Colonic biopsy revealed a histopathology suggestive of UC. Antibiotic treatment eliminated detectable levels of enteric pathogens but did not abate symptoms. Resolution of symptoms was procurable with oral prednisone, but tapering of corticosteroids was only achievable in combination therapy with vancomycin and metronidazole.
  
  
  CONCLUSIONS
  An infectious pathogen may have both precipitated and exacerbated autoimmune disease attributes in UC, symptoms of which could be resolved only with a combination of corticosteroids, vancomycin and metronidazole. This may warrant the need for more perceptive scrutiny of C. difficile and the like in patients with UC.
authors.affiliation: University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. Jminer@ouhsc.edu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Miner
authors.forename: M Monem
authors.initials: MM
authors.lastname: Gillan
authors.forename: Philip
authors.initials: P
authors.lastname: Alex
authors.forename: Michael
authors.initials: M
authors.lastname: Centola
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016360:Clostridioides difficile; D003015:Clostridium Infections; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000382:microbiology*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D013256:Steroids / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids; D008795:Metronidazole; D014640:Vancomycin; D011241:Prednisone