title: Thalidomide as rescue therapy for acute severe ulcerative colitis.
abstract: BACKGROUND
  Acute severe exacerbations of Ulcerative Colitis (UC) represent a medical emergency in children and adults. Intravenous steroids remain the first line therapy for this condition, although the steroid refractoriness is common. Second-line therapy, based on the infliximab or thiopurines should be started if no response to corticosteroids is noted. The use of infliximab in children with acute severe UC, nevertheless, does not avoid the colectomy in all cases.
  
  
  METHODS
  We present a case of severe acute UC in a paediatric patient successfully treated with thalidomide following the failed treatment with infliximab and a review of the literature.
  
  
  CONCLUSIONS
  This is the first case of a patient presenting with acute severe UC who was treated with thalidomide, with favorable evolution. In our case the use of this drug was able to avoid the colectomy that represent the conventional but very invasive recommended therapeutic option of this condition. Therefore, thalidomide may be considered as rescue therapy in selected and carefully monitored cases of acute severe CU.
authors.affiliation: Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy. diamanti@opbg.net.
authors.forename: A
authors.initials: A
authors.lastname: Diamanti
authors.forename: D
authors.initials: D
authors.lastname: Knafelz
authors.forename: F
authors.initials: F
authors.lastname: Panetta
authors.forename: P
authors.initials: P
authors.lastname: De Angelis
authors.forename: M
authors.initials: M
authors.lastname: Candusso
authors.forename: F
authors.initials: F
authors.lastname: Bracci
authors.forename: B
authors.initials: B
authors.lastname: Papadatou
authors.forename: P
authors.initials: P
authors.lastname: Francalanci
authors.forename: L
authors.initials: L
authors.lastname: Monti
authors.forename: G
authors.initials: G
authors.lastname: Torre
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D002648:Child; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D003106:Colon / Q000473:pathology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D011860:Radiography, Abdominal; D013792:Thalidomide / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D013792:Thalidomide; D000069285:Infliximab