title: Oral tacrolimus for megacolon in patients with severe ulcerative colitis.
abstract: Toxic megacolon is an infrequent but life-threatening complication that occurs most commonly in patients with severe ulcerative colitis. Intravenous steroids are often recommended for patients with toxic megacolon secondary to ulcerative colitis. However, steroid dependency may mask the presence of intra-abdominal sepsis and is associated with refractoriness, during which cytomegalovirus reactivation may occur. In this report, we present two rare cases of megacolon accompanying pancolonic severe ulcerative colitis that were successfully treated with oral tacrolimus, including one steroid-naïve patient. In cases of ulcerative colitis with megacolon, treatment with oral tacrolimus is recommended, thereby avoiding steroid dependency and improving the long-term prognosis.
authors.affiliation: The Second Department of Internal Medicine, Osaka Medical College, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Narabayashi
authors.forename: Takuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Taisuke
authors.initials: T
authors.lastname: Sakanaka
authors.forename: Munetaka
authors.initials: M
authors.lastname: Iguchi
authors.forename: Kaori
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Naoki
authors.initials: N
authors.lastname: Yorifuji
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kakimoto
authors.forename: Sadaharu
authors.initials: S
authors.lastname: Nouda
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Okada
authors.forename: Kumi
authors.initials: K
authors.lastname: Ishida
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Abe
authors.forename: Daisuke
authors.initials: D
authors.lastname: Masuda
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Shinya
authors.initials: S
authors.lastname: Fukunishi
authors.forename: Eiji
authors.initials: E
authors.lastname: Umegaki
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
mesh_terms: D000284:Administration, Oral; D003093:Colitis, Ulcerative / Q000150:complications*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008532:Megacolon, Toxic / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D011379:Prognosis; D016559:Tacrolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus