title: Steroid-refractory ulcerative colitis and associated primary sclerosing cholangitis treated with infliximab.
abstract: Primary sclerosing cholangitis is an infrequent extraintestinal manifestation of ulcerative colitis. Damage to bile ducts is irreversible and medical therapies to prevent progression of the disease are usually ineffective. We describe a patient with long-standing ulcerative colitis, which was refractory to corticosteroid therapy who developed primary sclerosing cholangitis (biochemical stage II/IV) in the course of his pancolitis. Treatment with infliximab (5 mg/kg as an induction dose followed by maintenance doses every two months) was indicated because of steroid-dependent disease associated to primary sclerosing cholangitis as well as sacroiliitis and uveitis and previous episode of severe azathioprine-related hepatic toxicity. At present, after two years of follow-up, the patient is asymptomatic with normal liver tests and complete resumption of daily life activities. This case draws attention to the usefulness of anti-tumor necrosis factor-alpha therapy for the management of primary sclerosing cholangitis as extraintestinal manifestation of inflammatory bowel disease.
authors: Service of Gastroenterology, Hospital Universitario de Álava-Sede Txagorritxu, Universidad del País Vasco, E-01009 Vitoria-Gasteiz, Spain.
authors: Ileana
authors: I
authors: Duca
authors: Patricia
authors: P
authors: Ramírez de la Piscina
authors: Silvia
authors: S
authors: Estrada
authors: Rosario
authors: R
authors: Calderón
authors: Katerina
authors: K
authors: Spicakova
authors: Leire
authors: L
authors: Urtasun
authors: Carlos
authors: C
authors: Marra-López
authors: Salvador
authors: S
authors: Zabaleta
authors: Raquel
authors: R
authors: Bengoa
authors: María Asunción
authors: MA
authors: Marcaide
authors: Francisco
authors: F
authors: García-Campos
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004351:Drug Resistance; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D013256:Steroids; D000069285:Infliximab
keywords: Bile duct diseases; Infliximab; Monoclonal antibodies; Sclerosing cholangitis; Tumor necrosis factor-alpha; Ulcerative colitis
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