D0420 - Successful Treatment of Complicated Ulcerative Colitis With Oral Vancomycin in a Patient With Primary Sclerosing Cholangitis

Paul Gomez, MD¹, Brian M. Fung, MD¹, Rebecca McCollaum, FNP², Joseph David, MD^1
1University of Arizona College of Medicine, Phoenix, AZ; ²Arizona Digestive Health, Phoenix, AZ

Introduction: Ulcerative colitis with primary sclerosing cholangitis (UC-PSC) is associated with earlier age of onset and pancolitis, and is thought to be a distinct entity. Current therapeutic approaches to patients with UC-PSC are similar to patients with UC alone. Oral vancomycin has been shown to have therapeutic effects on colitis in patients with UC-PSC. We present a complicated case of UC-PSC that was successfully treated with oral vancomycin.

Case Description/Methods: A 28 year-old African-American male with a 2 year history of UC-PSC was referred to our inpatient service for severe UC (Mayo score 11) as well as night sweats, weight loss, and severe peripheral polyarthritis. He had previously failed adalimumab, azathioprine, and infliximab-dyyb. At the time of presentation, he had been on vedolizumab for 7 months, as well as amphotericin B and fluconazole for disseminated coccidiomycosis involving his lungs, skin, eyes and other organs. Stool pathogen panel was negative, and flexible sigmoidoscopy demonstrated Mayo 2 colitis. He had severe arthritis in both knees, along with less severe arthritis in other peripheral joints, and was unable to ambulate because of this. Synovial fluid aspirate of the knee was suggestive of inflammatory arthritis, though his coccidioides antigen was positive. Given the desire to avoid further immunosuppression with IV steroids, he was started on oral vancomycin 500 mg twice daily. Within 24 hours, he began to note improvement in all symptoms and within 7 days, his partial Mayo score was 0, and he was ambulating with minimal pain. Six months later, he has regained 15 pounds and remains in clinical remission of his colitis on oral vancomycin and vedolizumab, as well as antifungals and ursodiol. His alkaline phosphatase remains elevated and his MRCP continues to show intrahepatic PSC.

Discussion: Numerous case reports have described the benefit of oral vancomycin in patients with UC-PSC in both adult and pediatric patients. This case adds to that body of evidence, and also highlights the need for safe, effective agents for inflammatory bowel disease that can be used in patients without concern of activating or exacerbating infections such as tuberculosis, hepatitis B, or in the case of our patient, disseminated coccidiomycosis.


Disclosures:


Paul Gomez, MD¹, Brian M. Fung, MD¹, Rebecca McCollaum, FNP², Joseph David, MD¹. D0420 - Successful Treatment of Complicated Ulcerative Colitis With Oral Vancomycin in a Patient With Primary Sclerosing Cholangitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.